Multivisceral Surgery for Advanced Gynaecological Malignancies*

Background: The goal of this study was to determine whether multivisceral surgery for advanced primary or recurrent gynaecological malignancies has prognostic implications with regard to operative features, morbidity, quality of life, and survival. Methods: Between January 1991 and January 2000, we treated 48 patients suffering from advanced gynaecological tumours (except ovarian cancer) with 60 ultraradical surgical procedures. The most common indication for operation was recurrent cervical cancer (75%). Results: Macroscopically tumour-free situation (29%) after surgery represents the most important prognostic parameter. In our study, these patients and those with residual tumours of less than 2 cm in diameter (34%) had a median survival time of 12 months; those with a larger lesion (32%), only 5.5 months. The postoperative complications are representative of those associated with any major cancer operation. Two patients died within 30 days postoperatively. Half of the patients reported a better quality of life. Conclusions: Radical multivisceral surgery is feasible, safe and efficient for primary as well as for recurrent advanced gynaecological malignancies. It is justified also for complications of nonoperative therapy. The survival benefit for those patients in whom optimal surgical cytoreduction has been achieved is evident. Careful patient selection and complete interdisciplinary management are mandatory.