The role of CT in predicting the surgical feasibility of exenteration in recurrent carcinoma of the cervix

In women with recurrent cervical cancer, there is a 52% 5-year survival rate when exenteration of the centrally placed tumor is performed. If not exenterated, the 2-year survival rate is less than 2%. The purpose of this study is to ascertain whether CT can predict inoperability reliably leading to a reduction in operations which do not have a curative outcome. The records of patients with recurrence of cervical cancer who underwent laparotomies for exenteration over the last 10 years under the care of one surgeon were reviewed. The CT scans were retrospectively assessed by two radiologists without knowledge of the subsequent outcome of the laparotomy. CT scans on 31 patients were reviewed, 21 of whom underwent a radical surgical procedure. Using CT criteria, 9 cases were felt to be operable with a curative intent and the remaining 22 cases were deemed to be inoperable. The sensitivity of CT prediction of inoperability is 93% (95%Cl:66-100%) and the specificity is 47% (95%Cl:23-72%). In three cases ascites was the only abnormal finding other than the central pelvic mass and in all of these cases a radical procedure with clear resection margins was possible. When the group with ascites alone was not considered to have peritoneal disease underlying the ascites, the sensitivity of CT prediction of inoperability is 93% (95%Cl:66-100%) and the specificity of 65% (95%Cl:38-86%). If, in addition, lymphadenopathy is not taken as definite evidence of inoperability, the specificity rises to 82% (95%Cl:57-96%). A high quality CT scan is highly specific for predicting inoperability based on extension of the tumor to the pelvic side walls, encasement of adjacent vessels or ureteric dilatation and so should be a major tool in assessing women for radical surgical treatment of recurrent cervical cancer. If ascites is the only abnormal finding other than the central pelvic mass then exploration should be undertaken.