Surgical resection of locally advanced and recurrent cervix cancer. When? How? Which expected results?

Locally advanced cervix cancer diagnosis is not rare and recurrencerisk ranged from 6 to 50 % according to series, tumor stage andsize. In non metastatic patients an extended surgical resection canbe performed: colpohysterectomy, extended in most cases, or morefrequently a pelvic exenteration. Functional and psychological consequencesare extremely important and several procedures are routinelyused to improve decrease the complications rate. Reconstructiveprocedures include digestive, urinary or gynecological tractreconstruction and pelvic filling. Recent surgery and intensive caretechnique improvement permitted to decrease the rate of postoperativemortality (less than 8%) but pelvic exenteration morbidity remainsextremely high, ranging from 38 to 65%.In our experience, the overall 5 year-survival rate after surgicalresection follo wing chemoradiation with curative intent in locallyadvanced cancer was 72 %, without difference between Stage I, II(tumor>40mm) and III, IVa. Local control was 91% (mean followup: 50 months). The overall 5 year-survival rate after surgical resectionwith curative intent in recurrent cancer was 35 %. Surgicalresection with curative intent was more frequently performed incentro-pelvic recurrence than in latero- pelvic or bilateral recurrence.In consequence, surgical resections of such recurrences arestill under debate. However, surgical resection remains in mostcases the only therapy allowing survival and quality of life benefits.