Ultra-radical compartmentalized surgery in gynaecological oncology

Aims To describe “ultra-radical” surgery in gynaecological oncology. This is multivisceral pelvic resection aimed at the eradication of locally advanced and recurrent gynaecologic cancer with microscopically tumour-free margins (R0). Methods Up-dated analysis of a prospective trial evaluating oncologic outcome and treatment-related morbidity of ultra-radical compartmentalized surgery carried out by the author. Results From 8/1996 until 9/2005 74 patients with locally advanced and recurrent gynaecologic tumours have been treated with ultra-radical compartmentalized surgery. Eighteen patients with central disease underwent exenteration as multimesovisceral excision, 56 patients with pelvic side wall disease received laterally extended endopelvic resection. In 72 of the patients the tumours were removed with microscopically free margins (R0). Two patients with advanced age and extensive comorbidity respectively, died during the early postoperative period. Moderate and severe treatment-related morbidity was 66%. At a median follow-up period of 29 months (1–112 months) 5-year overall and recurrence-free survival probabilities are 56% (95% CI: 42–69) and 56% (42–70). Conclusion Ultra-radical compartmentalized pelvic surgery may salvage selected patients with locally advanced and recurrent gynaecologic malignancies including those with pelvic side wall disease traditionally not considered for surgical therapy.