Abstract
BackgroundPelvic exenteration is a procedure with high morbidity despite careful patient selection. This study investigates potential associations between perioperative markers and major postoperative complications including survival. MethodsRetrospectively collected data for 195 consecutive patients who underwent total pelvic exenteration (January 2015–February 2020) at a single tertiary university hospital were analyzed. ResultsThe 30-day mortality was 0.5%, and the rate of major postoperative complications (≥3 Clavien-Dindo) was 34.5%. Low albumin level (p = 0.02) and blood transfusion (p = 0.02) were significantly correlated with a major postoperative complication in univariate analyses. This had no impact on survival. Positive margins (p = 0.003), liver metastasis (p = 0.001) were related to poor survival in multivariate analyses for colorectal patients. A Charlson Comorbidity Index >6 (p < 0.05) was associated with poor survival in all patients. ConclusionThe occurrence of major postoperative complication does not negatively impact the overall survival. Pelvic exenteration is a potential life-prolonging operation when negative margins can be obtained, despite known risks for complications. Comorbidity is a predictor for inferior outcomes.
Highlights
Pelvic exenteration was first described in 1948 by Brunschwig [1], after performing en block resection of connected pelvic organs in a woman with recurrent cervical cancer
When focusing only on colorectal cancer patients, we found no difference in survival when comparing primary versus relapse cancer (p 1⁄4 0.98)
This study showed a low mortality rate (0.5%) and a major morbidity rate of 34.5% among patients undergoing pelvic exenteration for both recurrent and locally advanced pelvic malignancies
Summary
Pelvic exenteration was first described in 1948 by Brunschwig [1], after performing en block resection of connected pelvic organs in a woman with recurrent cervical cancer. The mortality after pelvic exenteration is reported as approximately 0.5%e2% [3,4] [5] It is a safe procedure when performed at a highly specialized surgical center. This study investigates potential associations between perioperative markers and major postoperative complications including survival. Low albumin level (p 1⁄4 0.02) and blood transfusion (p 1⁄4 0.02) were significantly correlated with a major postoperative complication in univariate analyses. Pelvic exenteration is a potential life-prolonging operation when negative margins can be obtained, despite known risks for complications.
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