HAMDULLAH SÖZEN, Özgür TOSUN, Engin ÇELİK, Yağmur MİNARECİ, İbrahim YALÇIN, D VATANSEVER, Samet TOPUZ, Yavuz SALİHOĞLU

Jinekolojik Kanserler ve Pelvik Egzenterasyon Kısa Dönem Sonuçları Tek Merkez Deneyimleri

Amaç: Pelvik egzenterasyon rekürren jinekolojik kanserlerde kür veya daha uzun sağkalım amacıyla uygulanan ultraradikal bir cerrahidir. Bu çalışmanın birincil amacı kliniğimizce pelvik egzenterasyon operasyonu uygulanan hastaların klinik özelliklerini, operatif ve postoperatif komplikasyon türlerini ve sıklığını tanımlamaktır. Kısa dönem ortalama sağkalım ve hastalıksız sağkalım rakamlarını belirlemek çalışmanın ikincil amacıdır. Gereçler ve Yöntem: Kliniğimizde 2013-2017 yılları arasında Pelvik egzenterasyon yöntemi ile opere edilen 14 nüks serviks, endometriyum, vagina kanserli hasta retrospektif olarak incelenmiştir. Bulgular: Hastaların 11 tanesi rekürren serviks kanseri 2 tanesi rekürren endometriyum kanseri 1 tanesi de rekürren vagina kanseri idi. Opere edilen hastaların ortanca yaş 52.5 olarak hesaplanmıştır. Hastaların çoğunluğu (%57) daha önce opere edilmeyen kemoradyoterapi ile tedavi edilen hastalardan oluşmakta idi. En sık uygulanan pelvik egzenterasyon tipi total pelvik egzenterasyon olup kraniokaudal sınıflamaya göre supralevator (Tip 1) egzenterasyondur. En sık postoperatif komplikasyon enfeksiyon, ortanca hastanede yatış süresi 17.5 gün hesaplanmıştır. Postoperatif cerrahi ihtiyacı olan hasta sayısı 2 (%14.2) olarak bulunmuştur. 2 yıllık ortalama sağkalım %57; 2 yıllık hastalıksız sağkalım %35 olarak saptanmıştır. Sonuç: Pelvik egzenterasyon operasyonunun yüksek komplikasyon rakamları ve hastane kalış süreleri olmak ile beraber jinekolojik tümörlerin rekürrens geliştiren bir grubunda tek küratif ve sağkalımı artırıcı cerrahidir yöntemdir. Anahtar Kelimeler: pelvik egzenterasyon,

Short Term Results of Pelvic Exenteration at Gynecological Cancers: An Experience of Single Institution

Objective: Pelvic exenteration, which is generally performed to treat gynecological cancers, is a ultraradical surgical treatment. The main aim of this study is describing the clinical, operative and postoperative features among the patients operated in our clinic by the technique of pelvic exenteration. Determining overall survival rates (OS) and disease free survival rates (DFS) among these patient group are the secondary aim of the study. Material and Methods: Fourteen patients operated in our clinic between 2013-2017 by the technique of pelvic exenteration due to recurrent cancer of vagina, cervix and endometrium are examined. Results: Of the 11 patients among the study group were operated due to cervical cancer. The number of recurrent endometrial cancer and vagina cancer were 2 and 1, respectively. The median age of the patients are calculated as 52.5. In our study group majority of the patients (57%) were treated primarily with chemoradiotherapy instead of surgical approach. The most common exenteration type is found total pelvic exenteration according to classic organ based classification and type 1 supralevator exenteration according to craniocaudal anotomic classification. The most frequent postoperative complication is determined as infection at incision area and abdomen. The median time of hospital stay is calculated as 17.5 days. Relaparotomy for complication was required on two patients (14.2%). Two years overall survival and two years disease free survival are calculated as 57% and 35%, respectively. Conclusion: Although high complication rates and longer hospital stay might be seen after pelvic exenteration, this type of ultraradical surgery is the only curative method and treatment modality that increase survival rates among the group of patients recurred due to some gynecological tumors.

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