Overall survival after pelvic exenteration for gynecologic malignancy

Shannon N. Westin, Vijayashri Rallapalli, Bryan Fellman, Diana L. Urbauer, Navdeep Pal, Michael M. Frumovitz, Lois M. Ramondetta, Diane C. Bodurka, Pedro T. Ramirez, Pamela T. Soliman

Research output: Contribution to journalArticlepeer-review

79 Scopus citations


Background Five-Year survival after pelvic exenteration for gynecologic malignancies has been reported as high as 60%. The objective of this study was to determine overall survival (OS) after pelvic exenteration and evaluate factors impacting outcome. Methods A retrospective review of all women who underwent pelvic exenteration at our institution between February 1993 and December 2010 was performed. OS was defined as time from exenteration to date of death or last contact. Survival analysis was performed using the Kaplan Meyer method. Multivariate analysis was performed to determine the impact of clinical and pathologic factors on survival outcomes. Results One hundred sixty patients with gynecologic malignancy underwent pelvic exenteration. Five-year recurrence free survival (RFS) was 33% (95%CI 0.25–0.40). Factors which negatively impacted RFS included shorter treatment-free interval (p =.050), vulvar primary (p =.032), positive margins (p <.001), lymphovascular space invasion (LVSI, p <.001), positive lymph nodes (p <.001) and perineural invasion (p = 0.030). In multivariate analysis, positive margins (p =.040), positive nodes (p <.001) and lymphovascular space invasion (LVSI, p =.003) retained a significant impact on RFS. Five-year OS was 40% (95% CI 0.32–0.48). Factors which negatively impacted OS included vulvar primary (p =.04), positive margins (p <.001), LVSI (p <.001), positive lymph nodes (p <.001) and perineural invasion (p =.008). In multivariate analysis, positive nodes (p =.001) and LVSI (p =.001) retained a significant impact on OS. Conclusion Five-year OS after pelvic exenteration was 40%. Survival outcomes have not significantly improved despite improvements in technique and patient selection. Multiple non-modifiable factors at the time of exenteration are associated with poor survival.

Original languageEnglish (US)
Pages (from-to)546-551
Number of pages6
JournalGynecologic oncology
Issue number3
StatePublished - Sep 2014


  • Cervical cancer
  • Endometrial cancer
  • Gynecologic malignancy
  • Overall survival
  • Pelvic exenteration
  • Vulvar cancer

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology


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