Exenteration For Pelvic Malignancies Research Articles

Pelvic exenteration: a retrospective study in a tertiary referral cancer center in the UK.

Pelvic exenteration (PE) is an extensive surgery that is indicated in cases of recurrent advanced gynecological cancer with curative and sometimes palliative intent. The procedure is associated with both high morbidity and mortality and as such is considered a highly specialist procedure. The aim of the study was to analyze surgical outcomes in women who underwent PE for advanced gynecological malignancy in a tertiary cancer referral center over 11 years. This is an observational retrospective single-center study. There were 17 patients included who underwent PE in Hull Royal Infirmary Hospital (Hull, UK) between 2010 and 2021. The main outcome measures were the perioperative complications, overall survival (OS), and recurrence free survival (RFS). Cumulative survival rates were reported at 1, 3 and 5 years. Univariate Cox regression analysis was undertaken to analyze factors that are prognostic for OS and RFS. Hazard Ratios (HR) with 95% confidence intervals (95% CI) were computed from the results of the Cox regression analyses. Kaplan-Meier survival curves were generated to visually display estimates of OS and RFS over the follow-up period. The median age at the time of surgery was 63.0 (IQR: 48.0-71.0). All patients received surgery with curative intent and complete tumor resection (R0) was achieved in 94.1% of cases. An overall 5-year survival was achieved in 63.7% of patients. Mean overall survival (OS) was 8.4 years (95% CI: 7.78-9.02). The RFS was 5.0 years (95% CI: 4.13-5.87). Both OS and RFS were significantly negatively affected by the hospital stay (P=0.020 and P=0.035, respectively), but not by the type of surgery (P=0.263 and P=0.826, respectively). The results of the study demonstrated stable and comparable outcomes in patients undergoing pelvic exenteration.

Risk factors associated with 30-day postoperative complications following contemporary pelvic exenterations for gynecologic cancer

Objectives: Pelvic exenteration (PE) is an uncommon radical procedure associated with high perioperative morbidity due to the nature and extent of surgery. Due to surgical innovation and perioperative care advances, postoperative outcomes may have improved for PE. The purpose of this study is to evaluate rates of 30-day postoperative complications (POC) and risk factors associated with POC following PE for gynecologic malignancies. Methods: Data was obtained from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. All patients who underwent PE for a gynecologic cancer from 2012-2018 were identified using appropriate CPT, ICD-9 and ICD-10 codes. Comparative analyses were performed and stratified by admission status to evaluate demographics, preoperative and intraoperative variables, and surgical outcomes. Statistical tests were performed with R Studio v.1.1.456. Results: Between 2012-2018, 473 patients who had undergone a PE for a gynecologic malignancy were identified. The median age at time of surgery was 59 years (range, 22-90 years) and median body mass index (BMI) was 26.1 kg/m2 (range, 15.5-65.7 kg/m2). The median operative time was 385 minutes (range, 55-1090 minutes). At the time of their PE, 21.2% of patients underwent a concurrent myocutaneous flap and 12.3% a urinary conduit. The median length of hospital stay was 10 days (range, 0-114 days). At time of discharge, 79.2% were discharged home, 20.4% were transferred to an acute care or rehab facility, and 0.4% expired. The overall POC rate was 75.9%, but when urinary tract infections and blood transfusions were excluded, the POC rate was 37.6%. The 30-day readmission rate was 20.3% and re-operation rate was 10.4%. Lower preoperative albumin and hematocrit values, longer operative times, higher American Society of Anesthesiology (ASA) class, concurrent flap, and urinary conduit procedures were associated with higher POC rates (Table 1). When adjusting for these factors on multivariate analysis, preoperative albumin levels, and longer operative times remained independent risk factors for higher POC rates. Download : Download high-res image (123KB) Download : Download full-size image Conclusions: There remains a high rate of 30-day POC following PE; although a significant proportion of the POC are driven by the development of urinary tract infections and administration of blood transfusions. The contemporary mortality rate appears to be lower than previously reported historical rates. Preoperative albumin levels and longer operative times may be modifiable risk factors that can reduce POC rates.

Urological complications after cystectomy as part of pelvic exenteration are higher than that after cystectomy for primary bladder malignancy.

Total cystectomy and subsequent reconstruction of the urinary tract may be required for primary malignancy of the bladder, or in the context of multi-visceral resection for more advanced pelvic tumors. Complications following urinary diversion are a major source of morbidity, particularly in pelvic exenteration (PE) patients. All patients who underwent radical cystectomy alone or during PE at a single tertiary referral centre between 2008 and 2014 were reviewed. Postoperative urological complications were collected and compared between groups. Two hundred and thirty-one patients underwent en bloc cystectomy (98 cystectomy alone, 133 as part of a PE). Postoperative urological complications occurred in 33% of the cystectomy alone group and 59% of the PE group (P < 0.001). PE for recurrence had higher complications than PE for primary malignancy (67% vs. 48%, P = 0.035). Urological leaks occurred in 3%, 6%, and 14% of patient who had cystectomy alone, PE for primary malignancy and PE for recurrence. Major blood loss and previous pelvic radiotherapy independently predicted conduit-associated complications in PE patients (P = 0.002 and 0.035). Urological complications of cystectomy, particularly urine leaks and sepsis, are more common in patients undergoing PE compared to those with cystectomy alone. Prior pelvic radiotherapy, the extent of surgical resection and major blood loss may contribute to urological morbidity. J. Surg. Oncol. 2017;115:307-311. © 2016 Wiley Periodicals, Inc.

Quality of life and other patient-reported outcomes following exenteration for pelvic malignancy

Pelvic exenteration is highly radical surgery offering the only potential cure for locally advanced pelvic cancer. This study compared quality of life and other relevant patient-reported outcomes over 12 months for patients who did and those who did not undergo pelvic exenteration. Consecutive patients referred for consideration of pelvic exenteration completed clinical and patient-reported outcome assessments at baseline, hospital discharge (exenteration patients only), and 1, 3, 6, 9 and 12 months. Outcomes included cancer-specific quality of life (Functional Assessment of Cancer Therapy - Colorectal; FACT-C), physical and mental health status (Short Form 36 version 2), psychological distress (Distress Thermometer), and pain (study-specific composite) scores. Linear mixed modelling compared trajectories between exenteration and no-exenteration groups. Among 182 patients, 148 (81.3 per cent) proceeded to exenteration. There were no baseline differences between the two groups. Among patients who had exenteration, the mean FACT-C score at baseline of 93.0 had reduced by 14·4 points at hospital discharge, but increased to 86·7 at 1 month after surgery and continued to improve, returning to baseline by 9 months. For patients in the no-exenteration group, FACT-C scores decreased between baseline and 1 month, increased slowly to 6 months and then began to decline at 9 months. There were few statistically or clinically significant differences in any patient-reported outcomes between the groups. Quality of life and related patient-reported outcomes improve rapidly after pelvic exenteration surgery. For 9 months after surgery, these outcomes are comparable with those of similar do patients who do not have surgery; thereafter, there is a decline in patients who do not have exenteration. Pelvic exenteration can be performed with acceptable quality of life and patient-reported outcomes.