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Diseases of the Colon and Rectum Jan 2024
Topics: Humans; Colostomy; Pelvic Exenteration; Urinary Diversion
PubMed: 37656738
DOI: 10.1097/DCR.0000000000002757 -
Diseases of the Colon and Rectum Oct 2023To comprehensively report complications associated with pelvic exenteration and to determine the strength of associations between 3 different grading methodologies and...
OBJECTIVE
To comprehensively report complications associated with pelvic exenteration and to determine the strength of associations between 3 different grading methodologies and length of stay, quality of life, and physical outcomes.
BACKGROUND
It is generally accepted that pelvic exenteration is associated with high rates of surgical morbidity. However, methods of reporting in the literature are inconsistent, making it difficult to compare surgical outcomes across studies to determine the impact of surgery on patients.
DESIGN
A retrospective study.
SETTINGS
This study was conducted at Royal Prince Alfred Hospital, Sydney, Australia.
PATIENTS
It included patients who underwent pelvic exenteration between December 2016 and August 2019.
MAIN OUTCOME MEASURES
Complications were classified according to the Clavien-Dindo classification, Comprehensive Complication Index, and number of postoperative complications. Correlations between length of stay, physical component score, 6-minute walk test, and sit-to-stand test, and complications as graded using the Clavien-Dindo classification, Comprehensive Complication Index, and the number of complications were explored using Pearson's or point biserial correlation tests.
RESULTS
In this study, 198 patients were included. The Clavien-Dindo classification was moderately positively correlated with length of stay ( r = 0.519; p < 0.0001), whereas Comprehensive Complication Index ( r = 0.744; p < 0.0001) and the number of complications ( r = 0.751; p < 0.0001) showed a strong correlation with length of stay. All these methodologies were moderately inversely correlated with a predischarge 6-minute walk test (Clavien-Dindo classification: r = -0.359, p = 0.008; Comprehensive Complication Index: r = -0.388, p = 0.007; number of complications: r = -0.467, p < 0.0001).
LIMITATIONS
This single-center retrospective study involves a small sample size. Classification of grade I and II complications in this cohort of patients who tend to have complex postoperative recovery was challenging and therefore incomplete. The incomplete data may have affected the correlations.
CONCLUSIONS
Comprehensive Complication Index and the number of postoperative complications were more strongly correlated with length of stay than the Clavien-Dindo classification in patients undergoing pelvic exenteration. Comprehensive Complication Index may be a better grading system to classify postoperative complications following pelvic exenteration. See Video Abstract at http://links.lww.com/DCR/B906 .
CLASIFICACIN DE LAS COMPLICACIONES EN LA EXENTERACIN PLVICA LIMITACIONES DE LOS SISTEMAS DE CLASIFICACIN ACTUALES
OBJETIVO:Este estudio tuvo como objetivo informar de manera integral las complicaciones asociadas con la exanteración pélvica y determinar la rlacion de las asociaciones entre tres metodologías de clasificación diferentes y la duración de la estadía, la calidad de vida y los resultados físicos.ANTECEDENTES:En general, se acepta que la exanteración pélvica se asocia con altas tasas de morbilidad quirúrgica. Sin embargo, los métodos de notificación en la literatura son inconsistentes, lo que dificulta la comparación de los resultados quirúrgicos entre estudios para determinar el impacto de la cirugía en los pacientes.DISEÑO:Este fue un estudio retrospectivo.AJUSTES:Este estudio se realizó en el Royal Prince Alfred Hospital, Sydney. Australia.PACIENTES:Se incluyeron pacientes a las que se les realizó exenteración pélvica entre diciembre de 2016 y agosto de 2019.PRINCIPALES MEDIDAS DE RESULTADO:Las complicaciones se clasificaron de acuerdo con la Clasificación de Clavien-Dindo, el Índice Integral de Complicaciones y el número de complicaciones posoperatorias. Correlaciones entre la duración de la estadía, la puntuación del componente físico, la prueba de caminata de 6 minutos y la prueba de sentarse y levantarse; y las complicaciones según la clasificación de Clavien-Dindo, el CCI y el número de complicaciones se exploraron mediante las pruebas de correlación biserial de Pearson o Point.RESULTADOS:Un total de 198 pacientes fueron incluidos en este estudio. La clasificación de Clavien-Dindo se correlacionó moderadamente positivamente con la duración de la estancia ( r = 0,519, p < 0,0001), mientras que el índice de complicaciones integrales ( r = 0,744, p < 0,0001) y el número de complicaciones ( r = 0,751, p < 0,0001) mostraron una fuerte correlación con la duración de la estancia. Todas estas metodologías se correlacionaron moderadamente inversamente con la prueba de caminata de 6 minutos antes del alta (Clasificación de Clavien-Dindo: r = -0,359, p = 0,008; Índice de Complicaciones Integrales: r = -0,388, p = 0,007; número de complicaciones: r = -0,467, p < 0,0001).LIMITACIONES:Un estudio retrospectivo de un solo centro incluye un tamaño de muestra pequeño. La clasificación de las complicaciones de grado I y II en esta cohorte de pacientes que tienden a tener una recuperación postoperatoria compleja fue un desafío y, por lo tanto, incompleta. Los datos incompletos pueden haber afectado las correlaciones.CONCLUSIONES:El Índice Integral de Complicaciones y el número de complicaciones postoperatorias se correlacionaron más con la duración de la estancia que la Clasificación de Clavien-Dindo en pacientes con exenteración pélvica. El Índice Integral de Complicaciones puede ser un mejor sistema de clasificación para clasificar las complicaciones posoperatorias después de la exenteración pélvica. Consulte Video Resumen en http://links.lww.com/DCR/B906 . (Traducción-Dr. Yolanda Colorado ).
Topics: Humans; Pelvic Exenteration; Retrospective Studies; Quality of Life; Postoperative Complications; Morbidity
PubMed: 35067502
DOI: 10.1097/DCR.0000000000002396 -
Journal of Surgical Oncology Jun 1988We present the results of 252 pelvic exenterations for primary and recurrent carcinoma of the cervix at the Hospital General de Mexico, a tertiary-care institution for... (Review)
Review
We present the results of 252 pelvic exenterations for primary and recurrent carcinoma of the cervix at the Hospital General de Mexico, a tertiary-care institution for the indigent. Emphasis is placed on the morbidity and mortality of the procedure in relation to patient selection. In underdeveloped countries, where early detection of cervical cancer is a rare event, pelvic exenteration must continue in the armamentarium of physicians; it can be associated with gains in the quality of life, with long-term survival, with effective rehabilitation, and possibly with cures.
Topics: Adult; Aged; Developing Countries; Female; Humans; Medical Indigency; Mexico; Middle Aged; Neoplasm Recurrence, Local; Pelvic Exenteration; Retrospective Studies; Uterine Cervical Neoplasms
PubMed: 3288809
DOI: 10.1002/jso.2930380214 -
The British Journal of Surgery Aug 2021
Topics: Aged; Anatomic Landmarks; Digestive System Surgical Procedures; Female; Humans; Pelvic Exenteration; Pelvis; Perineum; Rectal Neoplasms; Robotic Surgical Procedures
PubMed: 34291281
DOI: 10.1093/bjs/znab127 -
Cirugia Espanola Mar 2018Pelvic exenteration (PE) offers the best chance of cure for locally advanced primary or recurrent pelvic organ malignancies invading adjacent organs. The aims of this...
INTRODUCTION
Pelvic exenteration (PE) offers the best chance of cure for locally advanced primary or recurrent pelvic organ malignancies invading adjacent organs. The aims of this study were to analyse results for any pelvic exenteration that includes rectal resection and the analysis of results of fecal and urinary reconstruction.
METHOD
From January 2000 to April 2014, 111 PE with rectal resection for any pelvic cancer were analysed retrospectively at two national tertiary referral centers.
RESULTS
Thirty-six colorectal anastomosis were performed. Urologic reconstructions performed were 30 double barrelled wet colostomy (DBWC), 14 Bricker ileal conduit (BIC), and 2 ureterocutaneostomies. Postoperative complications occurred in 71 patients (64%). Six deaths (5.4%) occurred within 30 postoperative days. Five-year overall survival following R0 resection was 62.6%; R1: 42.7%; R2: 24.2% (P=.018). The resection margin status was associated with overall survival, local recurrence and distant recurrence.
CONCLUSION
Pelvic exenterations for any cause need to be performed in referral centers and by specialized surgeons. Anastomosis after modified supralevator pelvic exenteration for ovarian cancer, is safe. DBWC can be considered a valid option for urologic reconstruction. The most important prognostic factor after pelvic exenteration for malignant pelvic tumors is the status of surgical margins.
Topics: Aged; Digestive System Surgical Procedures; Female; Humans; Male; Middle Aged; Pelvic Exenteration; Pelvic Neoplasms; Rectum; Retrospective Studies; Tertiary Care Centers; Urologic Surgical Procedures
PubMed: 29229359
DOI: 10.1016/j.ciresp.2017.11.001 -
Diseases of the Colon and Rectum May 2017
Topics: Adenocarcinoma; Colostomy; Humans; Lymph Node Excision; Myocutaneous Flap; Pelvic Exenteration; Rectal Neoplasms; Robotic Surgical Procedures; Urinary Diversion
PubMed: 28383456
DOI: 10.1097/DCR.0000000000000718 -
International Journal of Gynecological... Oct 2020
Topics: Colostomy; Female; Humans; Pelvic Exenteration; Urinary Diversion
PubMed: 32079710
DOI: 10.1136/ijgc-2019-000993 -
In Vivo (Athens, Greece) 2019Although pelvic exenteration is an aggressive surgical procedure, it remains almost the only curative solution for patients diagnosed with large pelvic malignancies. (Meta-Analysis)
Meta-Analysis
BACKGROUND/AIM
Although pelvic exenteration is an aggressive surgical procedure, it remains almost the only curative solution for patients diagnosed with large pelvic malignancies.
PATIENTS AND METHODS
We present a series of 100 patients submitted to pelvic exenteration with curative intent.
RESULTS
The origin of the primary tumor was most commonly represented by cervical cancer, followed by, endometrial cancer, rectal cancer, ovarian cancer and vulvo-vaginal cancer. An R0 resection was confirmed in 68 cases, while the remaining 32 cases presented lateral positive resection margins or perineal positive margins. The postoperative morbidity rate was 37% while the mortality rate was 3%. As for the-long term outcomes, the median overall survival time was 38.7 months, being most significantly influenced by the origin of the primary tumor.
CONCLUSION
Although pelvic exenteration is still associated with an increased morbidity, an important improvement in the long-term survival can be achieved, especially if radical resection is feasible.
Topics: Adult; Aged; Disease Management; Female; Humans; Male; Middle Aged; Neoplasm Grading; Neoplasm Recurrence, Local; Neoplasm Staging; Pelvic Exenteration; Pelvic Neoplasms; Prognosis; Treatment Outcome; Tumor Burden
PubMed: 31662557
DOI: 10.21873/invivo.11723 -
Der Chirurg; Zeitschrift Fur Alle... Oct 2010Over the last decades total pelvic exenteration (TPE) has evolved into an established and safe surgical technique for locally advanced pelvic malignancies. Depending on...
Over the last decades total pelvic exenteration (TPE) has evolved into an established and safe surgical technique for locally advanced pelvic malignancies. Depending on the type of cancer 5 year overall survival rates of up to 66% and a satisfactory postsurgical quality of life have been reported. Currently infiltration of the pelvic side wall and resectable metastases are not necessarily a contraindication to a curative approach; furthermore, TPE can also be useful in palliative surgery. In locally recurrent rectal cancer TPE is the treatment of choice if the tumor is deemed resectable. A multidisciplinary diagnostic and therapeutic approach is of utmost importance, hence patients should be treated in specialized centers.
Topics: Female; Humans; Neoplasm Recurrence, Local; Palliative Care; Pelvic Exenteration; Postoperative Complications; Plastic Surgery Procedures; Rectal Neoplasms; Surgery, Plastic; Survival Rate; Ureter; Uterine Cervical Neoplasms
PubMed: 20835694
DOI: 10.1007/s00104-010-1945-z -
Zhonghua Wei Chang Wai Ke Za Zhi =... Mar 2023Pelvic radiation injury can potentially involve multiple pelvic organs, and due to its progressive and irreversible nature, its late stage can be complicated by...
Pelvic radiation injury can potentially involve multiple pelvic organs, and due to its progressive and irreversible nature, its late stage can be complicated by fistulas, perforations, obstructions and other complications involved multiple pelvic organs, which seriously affect the long-term survival and the quality of life of patients. As a multidisciplinary surgical approach, pelvic exenteration has potential application in the treatment of late complications of pelvic radiation injury by completely removing the irradiated lesion, relieving symptoms and avoiding recurrence of symptoms. In clinical practice, we should advocate the concept of "pelvic radiation injury", emphasize multidisciplinary collaboration, fully evaluate the overall status of patients, primary tumor and pelvic radiation injury. We should follow the principles of "damage-control" and "extended resection", and follow the principle of enhanced recovery after surgery to achieve the goal of ensuring the surgical safety, relieving patients' symptoms and improving patients' quality of life and long-term survival.
Topics: Humans; Pelvic Exenteration; Postoperative Complications; Quality of Life; Radiation Injuries; Neoplasm Recurrence, Local; Retrospective Studies
PubMed: 36925123
DOI: 10.3760/cma.j.cn441530-20221206-00510