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The Lancet. Oncology Oct 2006Pelvic exenteration has been used for 60 years to treat cancers of the lower and middle female genital tract in radiated pelves. The mainstay for treatment success in... (Review)
Review
Pelvic exenteration has been used for 60 years to treat cancers of the lower and middle female genital tract in radiated pelves. The mainstay for treatment success in terms of locoregional control and long-term survival is resection of the pelvic tumour with clear margins (R0). New ablative techniques based on developmentally derived surgical anatomy and laterally extended endopelvic resection have raised the number of R0 resections done, even for tumours that extend to the pelvic side wall, which were traditionally judged a contraindication for exenteration. Although mortality has fallen to less than 5%, treatment-related severe morbidity of pelvic exenteration still exceeds 50%, possibly because of compromised healing of irradiated tissue and use of complex reconstructive techniques. The benefits of exenteration for patients who have advanced primary disease or recurrent tumours after surgery, versus those who have chemoradiotherapy, are not proven by results of controlled trials, but can be assumed from retrospective data. Comparative findings are missing, and arguments are unconvincing to favour pelvic exenteration over less extensive treatments and best supportive care for palliation of cancer symptoms in most patients.
Topics: Female; Genital Neoplasms, Female; Humans; Pelvic Exenteration; Survival Analysis; Survival Rate; Treatment Outcome
PubMed: 17012046
DOI: 10.1016/S1470-2045(06)70903-2 -
European Journal of Surgical Oncology :... Nov 2022
Topics: Humans; Pelvic Exenteration; Postoperative Complications; Retrospective Studies
PubMed: 36243647
DOI: 10.1016/j.ejso.2022.08.002 -
Annals of Surgery Nov 2019To determine factors associated with outcomes following pelvic exenteration for advanced nonrectal pelvic malignancy.
OBJECTIVE
To determine factors associated with outcomes following pelvic exenteration for advanced nonrectal pelvic malignancy.
BACKGROUND
The PelvEx Collaborative provides large volume data from specialist centers to ascertain factors associated with improved outcomes.
METHODS
Consecutive patients who underwent pelvic exenteration for nonrectal pelvic malignancy between 2006 and 2017 were identified from 22 tertiary centers. Patient demographics, neoadjuvant therapy, histopathological assessment, length of stay, 30-day major complication/mortality rate were recorded.The primary endpoints were factors associated with survival. The secondary endpoints included the difference in margin rates across the cohorts, impact of neoadjuvant treatment on survival, associated morbidity, and mortality.
RESULTS
One thousand two hundred ninety-three patients were identified. 40.4% (n = 523) had gynecological malignancies (endometrial, ovarian, cervical, and vaginal), 35.7% (n = 462) urological (bladder), 18.1% (n = 234) anal, and 5.7% had sarcoma (n = 74).The median age across the cohort was 63 years (range, 23-85). The median 30-day mortality rate was 1.7%, with the highest rates occurring following exenteration for recurrent sarcoma or locally advanced cervical cancer (3.3% each). The median length of hospital stay was 17.5 days. 34.5% of patients experienced a major complication, with highest rate occurring in those having salvage surgery for anal cancer.Multivariable analysis showed R0 resection was the main factor associated with long-term survival. The 3-year overall-survival rate for R0 resection was 48% for endometrial malignancy, 40.6% for ovarian, 49.4% for cervical, 43.8% for vaginal, 59% for bladder, 48.3% for anal, and 48.1% for sarcoma.
CONCLUSION
Pelvic exenteration remains an important treatment in selected patients with advanced or recurrent nonrectal pelvic malignancy. The range in 3-year overall survival following R0 resection (40%-59%) reflects the diversity of tumor types.
Topics: Aged; Aged, 80 and over; Cause of Death; Cohort Studies; Databases, Factual; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Pelvic Exenteration; Pelvic Neoplasms; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Survival Analysis; Tertiary Care Centers
PubMed: 31634184
DOI: 10.1097/SLA.0000000000003533 -
The Surgeon : Journal of the Royal... Dec 2023Pelvic exenteration is a radical procedure used to treat locally advanced and/or recurrent pelvic malignancies. Different reconstruction options exist, the most popular... (Review)
Review
AIM
Pelvic exenteration is a radical procedure used to treat locally advanced and/or recurrent pelvic malignancies. Different reconstruction options exist, the most popular being the end colostomy with ileal conduit. The double barrel wet colostomy (DBWC) offers concomitant fecal and urinary diversion through a single stoma, but is infrequently utilized. We aim to review the evidence base of the postoperative complications, long-term oncologic risks and quality of life following creation of a double barrel wet colostomy.
METHODS
A narrative review of the literature was performed evaluating the DBWC. Patient demographics, perioperative complications, operative variables, long terms oncologic outcomes and quality of life data were extracted. Descriptive statistics were used to define the data.
RESULTS
Fourteen articles with a total of 300 patients undergoing DBWC following pelvic exenteration were selected. 41% of malignancies were gastrointestinal in origin while 41.7% were gynecologic and 5.3% genitourinary. 42% of patients experienced at least one complication within in 40 days of surgery, the most common being wound infection (8.7%) and urinary leak (8.3%). There was no evidence of malignancy within the DBWC during long-term surveillance. Quality of life following DBWC is comparable to other reconstructive methods.
CONCLUSION
The DBWC is a well described reconstructive method for urinary and fecal diversion utilizing a single stoma following pelvic exenteration. The short- and long-term outcomes following DBWC are comparable to other reconstructive methods and the quality of life with a DBWC is acceptable. DBWC should remain a readily available option for reconstruction following pelvic exenteration.
Topics: Humans; Female; Pelvic Exenteration; Colostomy; Quality of Life; Urinary Diversion; Urinary Tract
PubMed: 37087331
DOI: 10.1016/j.surge.2023.03.004 -
Colorectal Disease : the Official... Mar 2021This study aims to assess surgical outcomes and survival following first, second and third pelvic exenterations for pelvic malignancy.
AIM
This study aims to assess surgical outcomes and survival following first, second and third pelvic exenterations for pelvic malignancy.
METHOD
Consecutive patients undergoing pelvic exenteration for pelvic malignancy at a quaternary referral centre from January 1994 and December 2017 were included. Demographics and surgical outcomes were compared between patients who underwent first, second and third pelvic exenterations by generalized mixed modelling with repeated measures. Survival was assessed using Cox proportional hazards models and Kaplan-Meier plots.
RESULTS
Of the 642 exenterations reviewed, 29 (4.5%) were second and 6 (0.9%) were third exenterations. Patients selected for repeat exenteration were more likely to have asymptomatic local recurrences detected on routine surveillance (P < 0.001). Postoperative wound complications increased with repeat exenteration (6%, 17%, 33%; P = 0.003, respectively). Additionally, postoperative length of stay increased from 27 to 38 and 48 days, respectively (P = 0.004). Median survival from first exenteration was 4.75, 5.30 and 8.14 years respectively amongst first, second and third exenteration cohorts (P = 0.849). Median survival from the most recent exenteration was 4.75 years after a first exenteration, 2.02 years after a second exenteration and 1.45 years after a third exenteration (P = 0.0546).
CONCLUSION
This study demonstrates that repeat exenteration for recurrent pelvic malignancy is feasible but is associated with increased complication rates and length of admission and reduced likelihood of attaining R0 margin. Moreover, these data indicate that repeat exenteration does not afford a survival advantage compared with patients having a single exenteration. These data suggest that repeat exenteration for recurrent pelvic malignancy may be of questionable therapeutic value.
Topics: Humans; Margins of Excision; Neoplasm Recurrence, Local; Pelvic Exenteration; Pelvic Neoplasms; Postoperative Complications; Proportional Hazards Models; Retrospective Studies; Treatment Outcome
PubMed: 33058495
DOI: 10.1111/codi.15402 -
Journal of Minimally Invasive Gynecology 2019To assess the feasibility and efficacy of minimally invasive pelvic exenteration (MIPE) in a multi-institutional Italian case series of women with gynecologic cancer and... (Review)
Review
STUDY OBJECTIVE
To assess the feasibility and efficacy of minimally invasive pelvic exenteration (MIPE) in a multi-institutional Italian case series of women with gynecologic cancer and a review of the literature.
DESIGN
Retrospective cohort study (Canadian Task Force classification II-2).
SETTING
Three Italian university/teaching hospitals: "Agostino Gemelli" Foundation University Hospital in Rome, "ARNAS Civico Di Cristina Benfratelli" Hospital in Palermo, and "Maggiore della Carità" Hospital in Novara.
PATIENTS
We reviewed all consecutive cases with gynecologic malignancies in this multi-institutional setting recorded between March 2014 and June 2017. Women with primary or central recurrent/persistent gynecologic cancer considered suitable for exenterative surgery after multidisciplinary tumor board discussion were included. Clinicopathological, perioperative, and survival data were retrieved from the institutional electronic database (STAR center).
INTERVENTIONS
All patients underwent total or anterior MIPE with a laparoscopic or robotic approach.
MEASUREMENTS AND MAIN RESULTS
Twenty-three patients underwent MIPE during the study period, including 12 (52.1%) by a laparoscopic approach and 11 (47.9%) by a robotic approach. All but 1 woman underwent MIPE for recurrent disease. The overall median operative time was 540 minutes (range, 310-720 minutes) with laparoscopy, slightly longer than with the robotic approach (p = .04). Median estimated blood loss was 400 mL (range, 200-600 mL). R0 resection was achieved in 17 of 23 patients (73.9%). There were no perioperative deaths. Early major postoperative complications occurred in 2 patients (8.7%). The median duration of hospitalization was 10 days (range, 6-33 days). With a median follow-up of 15 months, 11 patients (47.8%) developed recurrence. The median disease-free survival was 11 months (range, 5-18 months). To date, 155 MIPEs for gynecologic cancers have been reported in the literature. Among these, 12.6% had major postoperative complications, and overall postoperative mortality was 0.6%.
CONCLUSION
MIPE is a feasible procedure with low rate of intraoperative and postoperative complications. Careful patient selection is crucial to balance perioperative risks and potential survival benefits and to achieve complete tumor resection.
Topics: Adult; Aged; Cytoreduction Surgical Procedures; Female; Genital Neoplasms, Female; Humans; Middle Aged; Minimally Invasive Surgical Procedures; Pelvic Exenteration; Retrospective Studies
PubMed: 30611973
DOI: 10.1016/j.jmig.2018.12.019 -
Clinical Obstetrics and Gynecology Dec 1990
Review
Topics: Female; Humans; Pelvic Exenteration; Recurrence; Uterine Cervical Neoplasms
PubMed: 2289357
DOI: 10.1097/00003081-199012000-00026 -
Annals of Surgical Oncology May 2006
Review
Topics: Humans; Palliative Care; Patient Selection; Pelvic Exenteration; Pelvic Neoplasms; Survival Rate
PubMed: 16538402
DOI: 10.1245/ASO.2006.03.082 -
International Journal of Gynaecology... Apr 2014Cervical cancer represents one of the most common types of neoplasia among women; the use of minimally invasive techniques in the treatment of cervical cancer is a... (Review)
Review
BACKGROUND
Cervical cancer represents one of the most common types of neoplasia among women; the use of minimally invasive techniques in the treatment of cervical cancer is a challenge.
OBJECTIVES
To present evidence regarding robotic technology in the performance of pelvic exenteration in cases of cervical cancer.
SEARCH STRATEGY
PubMed and Scopus databases were searched.
SELECTION CRITERIA
Articles examining the use of robotic technology for pelvic exenteration in cases of cervical cancer were included.
DATA COLLECTION AND ANALYSIS
Four studies were included.
MAIN RESULTS
Most cancers treated with robotic-assisted pelvic exenteration were squamous cell carcinomas of the cervix. The stage of primary cancer ranged from IB2 to IVA. In 7 of the 8 patients, anterior pelvic exenteration was performed; the other patient underwent total pelvic exenteration. Procedure duration ranged from 375 to 600 minutes; blood loss was 200-550 mL. Postoperative complications occurred in 2 of the 8 patients and included perineal abscess, Miami pouch fistula, and ureteral stenosis. Postoperative hospital stay ranged from 3 to 53 days, and postoperative follow-up ranged from 2 to 31 months.
CONCLUSIONS
The gold standard for pelvic exenteration remains the open surgical approach; however, the application of robotic technology could be an alternate choice associated with excellent results.
Topics: Carcinoma, Squamous Cell; Female; Humans; Length of Stay; Neoplasm Staging; Pelvic Exenteration; Postoperative Complications; Robotics; Treatment Outcome; Uterine Cervical Neoplasms
PubMed: 24447415
DOI: 10.1016/j.ijgo.2013.09.032 -
European Journal of Surgical Oncology :... Jun 2022Pelvic exenteration is a procedure with high morbidity despite careful patient selection. This study investigates potential associations between perioperative markers...
BACKGROUND
Pelvic 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.
METHODS
Retrospectively collected data for 195 consecutive patients who underwent total pelvic exenteration (January 2015-February 2020) at a single tertiary university hospital were analyzed.
RESULTS
The 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.
CONCLUSION
The 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.
Topics: Humans; Morbidity; Neoplasm Recurrence, Local; Pelvic Exenteration; Postoperative Complications; Retrospective Studies
PubMed: 34998633
DOI: 10.1016/j.ejso.2021.12.472