Pelvic exenteration, University of Michigan: 100 patients at 5 years

Article Abstract:

A report is provided of long-term follow-up (at least five years, or until death) of 100 patients who underwent pelvic exenteration. This is an extremely radical procedure for treating gynecologic cancer, in which all or most of the pelvic organs (uterus, vagina, vulva, bowel, bladder, ovaries, lymph nodes) and surrounding tissue are removed. Sixty-nine patients underwent total procedures (the most extensive), while the remainder had less radical surgery. The overall 5- and 10-year survival rates were 61 and 58 percent, respectively. When disease had spread to nearby lymph nodes, survival was greatly reduced to 8 percent at three years and 0 percent at five years. Patients with smaller lesions had a better survival rate than those with larger lesions, as did those with longer intervals between the initial diagnosis and exenteration. Patients with squamous cell carcinoma of the cervix, vagina, or vulva had better survival rates than patients with adenocarcinoma. Forty-nine patients experienced complications after exenteration, including obstruction of the small intestine and the development of fistulas (abnormal passageways) between the vagina and the bladder or bowel, or between the intestinal tract and the skin. Two patients died soon after surgery. Thirty-one patients underwent vaginal reconstruction. An extensive discussion regarding this radical, "last resort" procedure is provided. It should be carried out only in patients for whom return to a satisfactory quality of life seems likely. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Cancer, Pelvic cancer, Pelvic exenteration

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Urinary incontinence following radical vulvectomy

Article Abstract:

Cancer of the vulva, the outer area at the entrance to the vagina, can be treated by removing the entire vulva (radical vulvectomy) or a portion of the vulva (hemivulvectomy). Short-term complications include wound infections, bleeding and wound breakdown. Over the longer term, women may experience involuntary leakage of urine (incontinence). The incidence of incontinence related to the surgical procedure has not been well studied. Urinary incontinence followed by radical vulvectomy was studied among 21 patients treated for cancer of the vulva. In four women undergoing radical vulvectomies, the urethra, the tube carrying urine from the bladder, was partially removed. In 14 women the tissue removed was within one centimeter (0.4 inches) of the urethra. A change in urine control was experienced by six patients (28 percent), while three developed total incontinence, two developed stress incontinence (leakage of urine when coughing or straining) and one urge incontinence (dribbling prior to urinating). None of the patients who had a vulvectomy that did not involve the urethra or come near the urethra developed incontinence. All of the patients with urethral involvement developed some type of incontinence. Although it does not appear that vulvectomy itself causes urinary incontinence, when surgery involves removing a portion of the urethra or manipulation of the tissue nearby, incontinence results. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Complications and side effects, Urinary incontinence, Vulva, Vulvectomy

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The surgical management of recurrent squamous cell carcinoma of the vulva

Article Abstract:

Cancer of the vulva, the external portion of the female genitals, has a high treatment success rate. In cases where localized vulvar cancer recurs, surgical removal, radiation therapy or a combination therapy are the standard treatments. When regional lymph nodes contain cancer cells, survival is less likely. The cases of 34 patients with recurrent or persistent squamous cell cancer of the vulva are described. Treatment for the recurrence included: complete removal of the vulva in five patients, which had a survival rate of 80 percent; and pelvic organ removal in four patients, which had a 25 percent survival rate. The 25 patients having wide radical excision surgery had a 56 percent survival rate. None of the patients with lymph node involvement remained disease-free. At follow-up, there were 19 survivors who were free of disease, representing 56 percent of the original group. Ten out of the 15 patients who have died had metastatic disease, in which the cancer had spread to the local lymph nodes. The prognosis of patients with squamous cell cancer of the vulva is good if the regional lymph nodes are free of cancer at the time of treatment. Since most patients had the disease return within two years, close frequent follow-up is essential. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Squamous cell carcinoma, Vulvar cancer

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