Quality of Life after Palliative Pelvic Exenteration for Gynecologic Malignancy

Abstract

Case Summary: Patient is a 44yo female with metastatic vulvar squamous cell carcinoma (SCC) diagnosed after 1-year history of a vulvar lesion, initially treated with radiation and radical vulvectomy. Following vulvectomy she developed an enlarging chronic wound, exposing her pubic ramus. Biopsies revealed recurrent SCC and osteomyelitis of the pubic ramus. Pain associated with the wound severely limited her ability to sit and ambulate. A tumor board decided to proceed with a palliative total pelvic exenteration 21 months after initial diagnosis of SCC for pain relief, including removal of the uterus, right fallopian tube and ovary, bladder, distal ureters, vagina, rectum, pubic symphysis, and pubic rami. Perineal reconstruction was completed with left pedicled anterolateral thigh flap with pedicled vastus lateralis flap. Unfortunately, she developed severe left hip pain due to persistent osteomyelitis and was diagnosed with locally recurrent SCC a few months after surgery.