Abstract
PurposeThe aim of the present study is to investigate the prognostic significance of nutritional risk factors and sarcopenia on the outcome of patients with recurrent gynaecological malignancies treated by pelvic exenteration.MethodsWe retrospectively evaluated muscle body composite measurements based on pre-operative CT scans, nutritional risk factors as assessed by a validated pre-operative questionnaire, and clinical–pathological parameters in 65 consecutive patients with recurrent gynaecological malignancies, excluding ovarian cancer, treated by pelvic exenteration at the Royal Marsden Hospital London. Predictive value for postoperative morbidity was investigated by logistic regression analyses. Relevant parameters were included in uni- and multivariate survival analyses.ResultsWe found only (1) low muscle attenuation (MA)—an established factor for muscle depletion—and (2) moderate risk for malnutrition to be independently associated with shorter overall survival (p = 0.006 and p = 0.008, respectively). MA was significantly lower in overweight and obese patients (p = 0.04). Muscle body composite measurements were not predictive for post-operative morbidity.ConclusionThe study suggests that pre-operative low MA and moderate risk for malnutrition are associated with shorter survival in patients with recurrent gynaecological malignancies treated with pelvic exenteration. Further studies are needed to validate these findings in larger cohorts.
Highlights
Pelvic exenteration is the last therapeutic option in selected, heavily pre-treated patients with pelvic recurrent or persistent gynaecological malignancies
The aim of the present study is to investigate the effect of nutritional risk factors, as assessed in a questionnaire, and body composition, i.e. skeletal muscle mass and muscle attenuation (MA) assessed by Computed tomography (CT) imaging, on postoperative morbidity and survival in patients undergoing pelvic exenteration for recurrent or persistent gynaecological malignancies
Preoperative prediction of postoperative morbidity and survival in patients undergoing major surgery, including pelvic exenteration, is essential for patient selection to assure optimal outcomes. This is the first study to determine if malnutrition and sarcopenia impact on postoperative morbidity and survival in patients with recurrent gynaecological malignancies treated with pelvic exenteration
Summary
Pelvic exenteration is the last therapeutic option in selected, heavily pre-treated patients with pelvic recurrent or persistent gynaecological malignancies. Due to improvements in Preliminary results of this study have been presented as posters at the following scientific meetings and have been published as abstracts in the respective meeting journal [36–38]. Wissenschaftliche Tagung der Arbeitsgemeinschaft für Gynäkologische Onkologie (AGO) der OEGGG 2017, 27–29 April 2017 Salzburg, Austria. Proceedings of the International Cancer Imaging Society (ICIS) 17th Annual Teaching Course, 02–04 October 2017, Berlin, Germany. International meeting of the European Society of Gynaecological Oncology (ESGO), 04–07 November 2017; Vienna, Austria
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