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Introduction and objective To evaluate complications, morbidity and oncologic outcomes of pelvic exenteration as treatment for gynecologic malignancies. Materials and methods Between 2008 and 2015, a total of 35 patients underwent pelvic exenteration, due to recurrence of gynecological cancer. Surgical outcomes, early and late postoperative complications, and recurrence/survival outcomes were assessed. Results Mean patient age was 53.8 years. Anterior exenteration was done in 20 patients, while 15 were total exenterations. Ileal conduit was done in 24 patients, while 8 received a neobladder and 3 a cutaneous ureterostomy. Postoperative complications were divided in 2 groups, early ( 30 days). A total of 25 patients (71.4%) had one or more early complications; 16 (45.7%) had fever due to a urinary tract infection, pyelonephritis or intra-abdominal collection; 2 (5.7%) developed a vesicovaginal fistula; 4 (11.4%) a rectovaginal fistula; 3 (8.5%) acute kidney failure and one (2.85%) uronephrosis. Regarding to late complications, 8 patients (22.8%) had fever. Six (17%) presented with uronephrosis, and 5 (14.2%) with ureteral-pouch stricture. Five patients (14.2%) had acute renal insufficiency, 3 (8,6%) rectovaginal fistula and one (2.85%) urinary fistula. Mean follow up time was 20.3 month (2–60). A total of 22 patients (62.8%) were free of disease. Another 13 (37.1%) patients relapsed. Only 4 (11.4%) patients died after pelvic exenteration due to underlying disease. Conclusion Pelvic exenteration has a high rate of complications and morbidity, but can be the last curative opportunity in patients with recurrent or persistent gynecologic malignancies. This procedure should be performed by multidisciplinary, experienced teams in a tertiary medical center.

Resumen Contexto El tratamiento del cancer de prostata de alto riesgo exige un abordaje multimodal para mejorar el control de la enfermedad. Todavia no hay consenso respecto de cual debe ser la estrategia inicial de eleccion. El objetivo de este trabajo es describir los resultados de la prostatectomia radical como primer paso terapeutico en el tratamiento de los pacientes de alto riesgo. Adquisicion de la evidencia Se realizo una busqueda en PubMed de textos en ingles y castellano. Se incluyeron aquellos trabajos que describian los resultados de la prostatectomia radical en pacientes con cancer de prostata de alto riesgo, asi como tambien aquellos que los comparaban con otras alternativas de tratamiento. La ultima busqueda se realizo en noviembre de 2015. Sintesis de la evidencia Las ventajas de la prostatectomia radical incluyen: mejor analisis patologico, estadificacion mas precisa, mejor control local de la enfermedad, mejor estrategia de seguimiento y adyuvancia. Al comparar con radioterapia externa mas bloqueo hormonal, los pacientes prostatectomizados presentan mayores oportunidades de curacion y mejor supervivencia cancer especifica. Los pacientes que mas se favorecen con este abordaje son los mas jovenes, con menos comorbilidades y sin evidencia de metastasis organica. Conclusiones La evidencia cientifica disponible hasta el momento no esta exenta de sesgos y confundidores, sin embargo impresiona favorecer la prostatectomia radical como abordaje inicial de eleccion en el cancer de prostata de alto riesgo.