Total laparoscopic pelvic exenteration for a laterally recurrent cervical carcinoma with a vesicovaginal fistula that developed after concurrent chemoradiotherapy

Abstract

Objective: For locally advanced cervical carcinoma, concurrent chemoradiotherapy (CCRT) is the standard treatment, however, CCRT can lead to development of a vesicovaginal or rectovaginal fistula [1]. Treatment options are limited for patients with laterally recurrent cervical carcinoma and fistula formation after CCRT. Chemotherapy with bevacizumab is now used for recurrent or advanced cervical carcinoma, but this treatment is associated with fistula formation [2]. When the recurrent mass is confined to the pelvic cavity, complete surgical resection with negative margins offers the most promise; however, the resectability rate is low in cases of laterally recurrent tumor [3], which may include bony structures, and survival outcomes seem to be poor in cases of a laterally recurrent vs. centrally recurrent tumor, even when the primary tumor has been resected in full [4]. Because analyses have shown that laparoscopy optimizes visualization and thus provides for meticulous dissection and that laparoscopic pelvic exenteration, in comparison to open pelvic exenteration results in minimal intraoperative blood loss and complications, fewer postoperative complications, and a shorter hospital stay [5], we perform laparoscopic pelvic exenteration in cases of laterally recurrent cervical carcinoma.

Methods: A 52-year-old woman underwent CCRT for a 10-cm stage IVA cervical carcinoma. That involved the bladder and right ureter, causing right hydronephrosis. Seven months after the CCRT, a recurrent mass at the right pelvic sidewall and vesicovaginal fistula were detected. The mass involved the right ureter and bladder and was attached to the rectum. The patient's right renal function was lost.

Results: Total pelvic exenteration and right nephroureterectomy were performed laparoscopically. Operation time was 566min, and the blood loss volume was 250mL. Complete tumor clearance was achieved without any complication. No adjuvant treatment has been performed, and follow-up positron emission tomography-computed tomography has revealed no sign of recurrence during the 5months that have passed since the surgery.

Conclusion: Total laparoscopic pelvic exenteration is technically feasible for a laterally recurrent cervical carcinoma and vesicovaginal fistula that develop after CCRT.

Keywords: CCRT; Laterally recurrent cervical carcinoma; Total laparoscopic pelvic exenteration; Vesicovaginal fistula.