TY - JOUR
T1 - Exenterations 60 Years after first description; Results of a survey among US and German gynecologic oncology centers
AU - Marnitz, Simone
AU - Dowdy, Sean
AU - Lanowska, Malgorzata
AU - Schneider, Achim
AU - Podratz, Karl
AU - Köhler, Christhardt
PY - 2009/7
Y1 - 2009/7
N2 - Objective: Sixty years after exenterative surgery was introduced into gynecologic oncology, the indications and contraindications, techniques, and adjuvant therapies after exenteration are controversially discussed between gynecologic oncologists. Methods: To evaluate the current patterns of care, a questionnaire with 48 items was sent to 40 Society of Gynecologic Oncologists member clinics with fellowship programs and all 38 German teaching hospitals for gynecologic oncology. Results: The mean number of exenterations performed during the last 5 years was comparable in both countries. Consistently, (central) recurrent cervical cancer or persistent tumor after chemoradiation is the main indication. Before exenteration, positron emission tomographyYcomputed tomography is mostly performed in the United States, whereas magnetic resonance imaging is the preferred imaging tool in Germany. Staging is more often done surgically in the United States (61%) compared with Germany (32%). None of the US institutions recommend an exenteration for patients with International Federation of Gynecology and Obstetrics stage IVA in contrast to 43% in Germany. In the case of fistula to the bladder and/or rectum, exenteration was recommended only by 29% and 61% in US and German clinics, respectively. In Germany, interdisciplinarity with general surgeons, urologists, plastic surgeons, and radio-oncologists is more common. There is consensus to apply adjuvant therapy after exenteration in patients with positive margins and/or positive lymph nodes. However, adjuvant therapy is more frequently recommended in Germany (93%) than in the United States (74%). Conclusions: Our data reflect considerable differences about indications and contraindications, preoperative staging, and adjuvant therapy for pelvic exenteration between Germany and the United States.
AB - Objective: Sixty years after exenterative surgery was introduced into gynecologic oncology, the indications and contraindications, techniques, and adjuvant therapies after exenteration are controversially discussed between gynecologic oncologists. Methods: To evaluate the current patterns of care, a questionnaire with 48 items was sent to 40 Society of Gynecologic Oncologists member clinics with fellowship programs and all 38 German teaching hospitals for gynecologic oncology. Results: The mean number of exenterations performed during the last 5 years was comparable in both countries. Consistently, (central) recurrent cervical cancer or persistent tumor after chemoradiation is the main indication. Before exenteration, positron emission tomographyYcomputed tomography is mostly performed in the United States, whereas magnetic resonance imaging is the preferred imaging tool in Germany. Staging is more often done surgically in the United States (61%) compared with Germany (32%). None of the US institutions recommend an exenteration for patients with International Federation of Gynecology and Obstetrics stage IVA in contrast to 43% in Germany. In the case of fistula to the bladder and/or rectum, exenteration was recommended only by 29% and 61% in US and German clinics, respectively. In Germany, interdisciplinarity with general surgeons, urologists, plastic surgeons, and radio-oncologists is more common. There is consensus to apply adjuvant therapy after exenteration in patients with positive margins and/or positive lymph nodes. However, adjuvant therapy is more frequently recommended in Germany (93%) than in the United States (74%). Conclusions: Our data reflect considerable differences about indications and contraindications, preoperative staging, and adjuvant therapy for pelvic exenteration between Germany and the United States.
KW - Chemoradiation
KW - Indication
KW - Palliative exenteration
KW - Pelvic exenteration
KW - Primary cervical cancer
KW - Recurrent cervical cancer
KW - Survey
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U2 - 10.1111/IGC.0b013e3181a8351e
DO - 10.1111/IGC.0b013e3181a8351e
M3 - Article
C2 - 19574795
AN - SCOPUS:69349107489
SN - 1048-891X
VL - 19
SP - 974
EP - 977
JO - International Journal of Gynecological Cancer
JF - International Journal of Gynecological Cancer
IS - 5
ER -