A radical surgical procedure called pelvic exenteration may be curative for more than half of women with a form of advanced cervical cancer who have failed other treatments, according to a recent Northwestern Medicine study.
Stephen Graves, a third-year medical student, was the first author of the paper. Graves conducted the research while working in the lab of Shohreh Shahabi, MD, chief of Gynecologic Oncology in the Department of Obstetrics and Gynecology, and under the mentorship of corresponding author Brandon-Luke Seagle, MD, a fellow in gynecologic oncology.
Pelvic exenteration is an extreme surgery that involves the removal of all organs in the pelvic cavity, including the bladder, rectum and reproductive organs. The rare operation was originally developed with a palliative intent to help control intolerable symptoms. Today, exenteration is more often performed as a last chance of cure in women with recurrent cancer that hasn’t responded to less invasive therapies.
“Pelvic exenteration is something that has fallen out of favor for a long time, because it’s such a radical surgery,” Graves said. “Even before it fell out favor, it was rarely performed. So it was unclear how effective the surgery really was, and if it was worth it.”
The investigators, using data from the 1998 to 2011 National Cancer Database, aimed to determine more accurate survival rates for the surgery, particularly as advancements over the last few decades have led to new surgical techniques and decreased perioperative morbidity and mortality rates.
Looking at data from 313 women with advanced cervical cancer who underwent exenteration, the investigators found that the median overall survival was 24 months. But among women whose cancer was node-negative — meaning it had not spread to the lymph nodes — the outcomes were significantly better: median survival was more than 73 months, and the surgery was considered curative in more than half of such cases.
The study, the largest of its kind to analyze cervical cancer survival rates after pelvic exenteration surgery, was published in the International Journal of Gynecological Cancer.
“Because we looked at multiple histologic types, and pulled data from across the U.S., our power was high enough that we were able to draw more conclusions than other studies, and find that this surgery may actually be worthwhile,” Graves said. “Further, because of advances in reconstructive technologies — such as being able to create new bladders — the quality of life after surgery also now tends to be better, and complications are lower.”
The study authors note, however, that because of significant rates of complications with pelvic exenteration, the surgery still warrants careful selection. But the new findings may help physicians better identify patients who might benefit from such surgery.
In the future, Shahabi’s lab plans to investigate other aspects of pelvic exenteration outcomes. “One of our biggest questions is whether or not regional centers who perform the surgery more often might have better outcomes than places where the surgery is very rare,” Graves said. He was also a co-author on a recent study that investigated survival rates after pelvic exenteration for uterine malignancy, published in the journal Gynecologic Oncology.
Graves, a veteran who previously served in the Marine Corps for ten years, is enrolled in a combined MD/MBA degree, and will spend next year earning his MBA at the Kellogg School of Management. He will also use the year to conduct further research in Shahabi’s lab.
Wilberto Nieves-Neira, MD, associate professor of Obstetrics and Gynecology, was a principal investigator of the current paper. Anna Strohl, MD, a fellow in gynecologic oncology, was also a co-author. Shahabi and Nieves-Neira are both members of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.