Giuseppe Vizzielli1,2, Lucia Tortorella3, Carmine Conte3, Vito Chiantera4, Valerio Gallotta3, Nazario Foschi5, Martina Arcieri3, Gabriella Ferrandina3,6, Anna Fagotti3,6, Filiberto Zattoni7, Giovanni Scambia3,6, Alfredo Ercoli8. 1. Dipartimento Scienze della Salute della Donna e del Bambino e Sanità Pubblica, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy. giuseppevizzielli@yahoo.it. 2. Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy. giuseppevizzielli@yahoo.it. 3. Dipartimento Scienze della Salute della Donna e del Bambino e Sanità Pubblica, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy. 4. Division of Gynecologic Oncology, University of Palermo, Palermo, Italy. 5. Division of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy. 6. Dipartimento Scienze della Salute della Donna e del Bambino e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy. 7. Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy. 8. Department of Obstetrics and Gynecology, University of Messina, Messina, Italy.
Abstract
PURPOSE: Reporting the perioperative and survival outcomes of vaginectomy with respect to a matched series of pelvic exenteration (PE) in women with isolated recurrent cervical cancer. METHODS: The records of vaginal recurrent cervical cancer patients admitted at Fondazione Policlinico "Agostino Gemelli" IRCCS in Rome from January 2010 to June 2019 were retrospectively analyzed. A propensity-matched score analysis was performed by age, clinical stage, disease-free interval, and R0 resection. Postsurgical complications and survival rates were evaluated. RESULTS: Fifteen women underwent vaginectomy, and 30 patients were submitted to PE. No statistical differences were observed between the two groups at baseline characteristics. The vaginectomy procedures were successfully performed in all women, and no case required conversion to PE. Moreover, a higher rate of major postoperative complications after PE with respect to vaginectomy (p = 0.027) was recorded. Among them, three women required reoperation within 30 postoperative days, and four experienced two or more complications. Twenty-five (55.6%) women experienced recurrence: 8 of 25 (32.0%) in the vaginectomy group, and 17 of 25 (68%) in the PE group, with a median progression-free survival of 20 months and 13 months, respectively (p = 0.169). In total, 5 of 15 (33.3%) died of disease in the vaginectomy group and 13/30 (43.3%) in the PE group, with a median overall survival of 39 and 18 months for vaginectomy and PE, respectively (p = 0.161). CONCLUSIONS: The vaginectomy seems to allow for salvage treatment, such as radiotherapy and/or PE, but with a minimal impact on the quality of life in appropriately selected women with local recurrent cervical cancer.
PURPOSE: Reporting the perioperative and survival outcomes of vaginectomy with respect to a matched series of pelvic exenteration (PE) in women with isolated recurrent cervical cancer. METHODS: The records of vaginal recurrent cervical cancerpatients admitted at Fondazione Policlinico "Agostino Gemelli" IRCCS in Rome from January 2010 to June 2019 were retrospectively analyzed. A propensity-matched score analysis was performed by age, clinical stage, disease-free interval, and R0 resection. Postsurgical complications and survival rates were evaluated. RESULTS: Fifteen women underwent vaginectomy, and 30 patients were submitted to PE. No statistical differences were observed between the two groups at baseline characteristics. The vaginectomy procedures were successfully performed in all women, and no case required conversion to PE. Moreover, a higher rate of major postoperative complications after PE with respect to vaginectomy (p = 0.027) was recorded. Among them, three women required reoperation within 30 postoperative days, and four experienced two or more complications. Twenty-five (55.6%) women experienced recurrence: 8 of 25 (32.0%) in the vaginectomy group, and 17 of 25 (68%) in the PE group, with a median progression-free survival of 20 months and 13 months, respectively (p = 0.169). In total, 5 of 15 (33.3%) died of disease in the vaginectomy group and 13/30 (43.3%) in the PE group, with a median overall survival of 39 and 18 months for vaginectomy and PE, respectively (p = 0.161). CONCLUSIONS: The vaginectomy seems to allow for salvage treatment, such as radiotherapy and/or PE, but with a minimal impact on the quality of life in appropriately selected women with local recurrent cervical cancer.
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