-
Romanian Journal of Morphology and... 2019Pelvic exenteration (PE) is an extensive surgical procedure for locally advanced primary neoplasia (LAPN) or recurrent neoplasia (RN) that consists in the en bloc...
Pelvic exenteration (PE) is an extensive surgical procedure for locally advanced primary neoplasia (LAPN) or recurrent neoplasia (RN) that consists in the en bloc removal of the pelvic organs (rectum, internal genital organs and bladder) associated with pelvic lymph nodes. PE is classified into anterior, posterior and total, supra or infralevatorian approaches. Our aim was to evaluate the surgical procedure and the resection margins in correlation with postoperative complications and morbidity rates after PE in patients treated in a single surgical unit. The study group comprised patients diagnosed with different malignancies, surgically treated by using PE procedure, during 2012-2018. The cohort included 121 cases with LAPN (n=98, 80.99%) and RN (n=23, 19%), mostly female (n=114, 94.21%), with a mean age of 61.16 (33-85) years. LAPN had predominantly digestive (n=48, 49.98%) and gynecological (n=28, 28.57%) origins, while the majority of RN cases were cervical cancers (n=9, 39.13%). The univariate analysis showed that the gynecological origin of the tumor (p=0.02), urinary stoma (p=0.02) and posterior PE (PPE) (p=0.004) were significant prognostic factors for postoperative complications. After performing the multivariate analysis, only the gynecological origin (p=0.02) of the tumor and PPE (p=0.03) remained determining factors for postoperative complications. PE is a disabling surgical procedure associated with high postoperative mortality and morbidity, although it is often the only solution for advanced cases. The judicious selection of patients who can benefit from such extensive surgery is compulsory. Our study suggests that the gynecological origin of the tumor and PPE are key factors in postoperative complications.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Pelvic Exenteration; Pelvic Neoplasms; Pelvis
PubMed: 32239092
DOI: No ID Found -
The British Journal of Surgery Oct 2020
Topics: Global Health; Hospital Costs; Humans; Pelvic Exenteration
PubMed: 33460051
DOI: 10.1002/bjs.11924 -
European Urology Focus May 2021Little has been reported on urological complications of total pelvic exenteration (TPE) for locally advanced or recurrent rectal cancer.
BACKGROUND
Little has been reported on urological complications of total pelvic exenteration (TPE) for locally advanced or recurrent rectal cancer.
OBJECTIVE
To assess urological reconstructive outcomes and adverse events in this setting.
DESIGN, SETTING, AND PARTICIPANTS
A total of 104 patients underwent TPE from 2004 to 2016 in this single-centre, retrospective study. Electronic and paper records were evaluated for data extraction. Mean follow-up was 36.5 mo.
INTERVENTION
TPE.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Urological complications were analysed using two-tailed t and chi-square tests, binary logistic regression analysis.
RESULTS AND LIMITATIONS
Sixty-three (61%) patients received radiotherapy prior to TPE. Incontinent diversions included ileal conduit (n = 95), colonic conduits (n = 4), wet colostomy (n = 1), and cutaneous ureterostomy (n = 1). Three patients had a continent diversion. The overall urological complication rate was 54%. According to Clavien-Dindo classification, 30 patients, five patients, and one patient had grade III, IV, and V complications, respectively. The commonest complication was urinary tract infection (in 32 [31%] patients). Anastomotic leaks were seen in 14 (13%) cases, of which eight (8%) were urinary leaks. Fistulas were seen in three (3%) patients, involving the urinary system. A return to theatre was required in 12 (12%) patients. Ureteroenteric strictures were seen in seven (7%). No differences were seen in urological outcomes in patients with primary or recurrent rectal cancer (p = 0.69), or by radiation status (p = 0.24). The main limitation is the retrospective nature of the study.
CONCLUSIONS
TPE is complex with recognised high risk of morbidity. In this cohort, there was no significant difference in outcomes between primary and recurrent disease, and surgery after radiation.
PATIENT SUMMARY
In this study, we assessed urological complications following total pelvic exenteration. Urinary complications affected more than half of patients. Urinary tract infection is the commonest risk. Approximately one-third of patients required surgical, radiological, or endoscopic intervention ± intensive care admission. Radiation prior to the operation did not affect urinary complications.
Topics: Humans; Neoplasm Recurrence, Local; Pelvic Exenteration; Postoperative Complications; Rectal Neoplasms; Retrospective Studies; Urinary Tract Infections
PubMed: 32622667
DOI: 10.1016/j.euf.2020.06.008 -
Gynecologic Oncology Nov 2022To evaluate postoperative and oncologic outcomes associated with pelvic exenteration for non-ovarian gynecologic malignancies.
OBJECTIVE
To evaluate postoperative and oncologic outcomes associated with pelvic exenteration for non-ovarian gynecologic malignancies.
METHODS
This was a retrospective review of patients who underwent pelvic exenteration for non-ovarian gynecologic malignancies at our institution from 1/1/2010-12/31/2019. Palliative exenteration cases were excluded from survival analysis. Postoperative complications were early (≤30 days) or late (31-180 days). Complications were graded using a validated institutional scale. Major complications were considered grade ≥ 3. Categorical variables were compared using the chi-square test, and the Kaplan-Meier method was used for survival analysis.
RESULTS
Of 100 patients identified, 89 underwent pelvic exenteration for recurrent disease, 5 for palliation, 5 for primary disease, and 1 for persistent disease. Thirty percent had cervical, 27% vulvar, 24% uterine, and 19% vaginal cancer. Sixty-two percent underwent total, 30% anterior, and 8% posterior exenteration. No deaths occurred intraoperatively or within 30 days of surgery. Six patients died after 30 days. Ninety-seven experienced a perioperative complication-49 early, 1 late, and 47 both. Fifty experienced a major complication-22 (44%) early, 19 (38%) late, and 9 (18%) both. No variables were statistically associated with complication development. The 3-year progression-free survival rate was 61.0%; the 3-year overall survival rate was 61.6%. Of 58 surviving patients, 16 (28%) and 4 (7%) were alive after 5 and 10 years, respectively.
CONCLUSION
The overall complication rate for pelvic exenteration remains high. No variables demonstrated association with complication development as the rate was nearly 100%. The low rate of perioperative mortality is likely due to improved perioperative care.
Topics: Humans; Female; Genital Neoplasms, Female; Pelvic Exenteration; Survival Analysis; Retrospective Studies; Vaginal Neoplasms; Neoplasm Recurrence, Local
PubMed: 36064678
DOI: 10.1016/j.ygyno.2022.08.017 -
The British Journal of Surgery Jan 2023The number of units with experience in extended radical resections for advanced pelvic tumours has grown substantially in recent years. The use of complex vascular... (Review)
Review
BACKGROUND
The number of units with experience in extended radical resections for advanced pelvic tumours has grown substantially in recent years. The use of complex vascular resections and reconstructive techniques in these units is expected to increase with experience. This review aimed to provide a cutting-edge overview of this evolving surgical approach to complex pelvic tumours with vascular involvement.
METHODS
This was a narrative review of published data on major vascular resection and reconstruction for advanced pelvic tumours, including preoperative evaluation, techniques used, and outcomes. Advice for treatment decisions is provided, and based on current literature and the personal experience of the authors. Current controversies and future directions are discussed.
RESULTS
Major vascular resection and reconstruction during surgery for advanced pelvic tumours is associated with prolonged operating time (510-678 min) and significant blood loss (median 2-5 l). R0 resection can be achieved in 58-82 per cent at contemporary specialist units. The risk of major complications is similar to that of extended pelvic resection without vascular involvement (30-40 per cent) and perioperative mortality is acceptable (0-4 per cent). Long-term survival is achievable in approximately 50 per cent of patients.
CONCLUSION
En bloc resection of the common or external iliac vessels during exenterative pelvic surgery is a feasible strategy for patients with advanced tumours which infiltrate major pelvic vascular structures. Oncological, morbidity, and survival outcomes appear comparable to more central pelvic tumours. These encouraging outcomes, combined with an increasing interest in extended pelvic resections globally, will likely lead to more exenteration units developing oncovascular experience.
Topics: Humans; Pelvic Neoplasms; Pelvic Exenteration; Pelvis; Retrospective Studies; Neoplasm Recurrence, Local
PubMed: 36427187
DOI: 10.1093/bjs/znac414 -
Gynecologic Oncology May 2019To examine changes in performance and outcomes of pelvic exenteration for gynecologic malignancies.
OBJECTIVE
To examine changes in performance and outcomes of pelvic exenteration for gynecologic malignancies.
METHODS
This is a population-based retrospective study examining the Nationwide Inpatient Sample between 2001 and 2015. Women with cervical, uterine, vaginal, and vulvar malignancies who underwent pelvic exenteration were examined. Comorbidity, perioperative complications, total charges, length of stay, and mortality were assessed.
RESULTS
There were 2647 cases included. Cervical cancer was the most common malignancy (45.1%), followed by vaginal cancer (27.6%). 26.9% of women had a Charlson Comorbidity Index ≥3, which significantly increased from 23.3% in 2001-2005 to 33.3% in 2011-2015 (42.9% relative increase, P < 0.001). Obese women undergoing exenteration increased significantly from 4.5% in 2001-2005 to 19.4% in 2011-2015 (3.3-fold relative increase, P < 0.001). The perioperative complication rate was 68.1%, including 38.7% with multiple complications. The mortality rate was 1.9%. The number of women with multiple perioperative complications increased from 29.4% in 2001-2005 to 52.8% in 2011-2015 (78.6% relative increase, P < 0.001). More recent year of surgery, obesity, higher comorbidity, higher household income, surgery at large bedsize hospital, urinary diversion, vaginal reconstruction, and vulvar cancer were associated with an increased risk of multiple complications on multivariable analysis (all, P < 0.05). Median length of stay was 14 (IQR 9-21) days, and the number of women hospitalized ≥28 days significantly increased from 12.6% in 2001-2005 to 19.1% in 2011-2015 (51.6% relative increase, P < 0.001). The median corrected total charges increased from $121,854 to $185,100 between 2001 and 2015 (net difference +$63,246, 51.9% relative increase, P < 0.001).
CONCLUSION
Women undergoing pelvic exenteration for gynecologic malignancies became more obese and comorbid during the study period. Pelvic exenteration for women with gynecologic malignancies is associated with high morbidity and mortality as well as substantial treatment-related costs.
Topics: Aged; Comorbidity; Female; Genital Neoplasms, Female; Humans; Middle Aged; Obesity; Pelvic Exenteration; Retrospective Studies; Treatment Outcome; United States
PubMed: 30792003
DOI: 10.1016/j.ygyno.2019.02.002 -
Acta Chirurgica Belgica 2011The aim of this retrospective study is to present the oncological results obtained in a series of 106 patients who underwent a pelvic exenteration with curative intent.
INTRODUCTION
The aim of this retrospective study is to present the oncological results obtained in a series of 106 patients who underwent a pelvic exenteration with curative intent.
PATIENTS AND METHODS
Between December 1980 and December 2008 pelvic exenteration was performed in a series of 106 patients, in 69 for gynecologic cancer, in 29 for colorectal cancer, in 6 for urological and in 2 for skin cancer. In only 21 patients it was the primary treatment, in 85 it was for persistent or recurrent tumor. The resection was macroscopically complete in all patients.
RESULTS
Overall five-year and ten-year survival was 40% and 33% respectively, disease-free survival 41 and 37%. Survival was better for gynecological tumors than for the other tumors. After supralevatoric exenteration survival was 50% and 47% and better than after infralevatoric exenteration. Exenteration with extension beyond the classical plane of dissection resulted in a 5 year survival of 32%. The only significant difference found was according to the margin status. After R1 resection the median survival was 24 months and the 5-year survival only 9% whereas R0 resection resulted in a 5-year survival of 47% and a local recurrence rate of 13.5%. Fifteen patients died from an unrelated cause. Only 12% of the patients alive 5 years after the operation suffered from recurrent tumor and surgery cured half of them.
CONCLUSION
Pelvic exenteration in patients with advanced or recurrent pelvic cancer results in a long-term cure rate of about 50% if an R0 resection has been obtained.
Topics: Adenocarcinoma; Aged; Carcinoma, Squamous Cell; Disease-Free Survival; Female; Gastrointestinal Neoplasms; Genital Neoplasms, Female; Humans; Kaplan-Meier Estimate; Leiomyosarcoma; Male; Middle Aged; Neoplasm Recurrence, Local; Pelvic Exenteration; Retrospective Studies
PubMed: 22191128
DOI: No ID Found -
Zhonghua Wei Chang Wai Ke Za Zhi =... Mar 2023Locally advanced tumor with involvement of surrounding tissues and organs is a common situation in pelvic malignancies. Up to 10% of newly diagnosed rectal cancer cases...
Locally advanced tumor with involvement of surrounding tissues and organs is a common situation in pelvic malignancies. Up to 10% of newly diagnosed rectal cancer cases infiltrate to adjacent tissues and organs. Satisfactory resection margins obtained by pelvic exenteration can achieve a 5-year survival rate similar to cases that without adjacent tissue invasion. The 5-year survival rate of patients with locally recurrent pelvic malignancies is almost zero if they are treated only with radiotherapy and chemotherapy. To obtain negative margins through pelvic exenteration is the only chance for a long-term survival of these patients. However, pelvic exenteration is a complicated procedure with higher morbidity and mortality. The development of fascia anatomy enables surgeons to have a deeper understanding and comprehensive application of pelvic fasciae. Meanwhile, the improvement of laparoscopic technology provides a clearer view for surgeons and enables the application of minimally invasive techniques in complex pelvic exenteration. The fascial space priority approach is based on the fascia anatomy of pelvis and giving priority to the separation of the pelvic avascular fascial spaces, which provides a reproducible surgical approach for complex pelvic exenteration.
Topics: Humans; Pelvic Exenteration; Pelvic Neoplasms; Neoplasm Recurrence, Local; Rectal Neoplasms; Pelvis; Retrospective Studies
PubMed: 36925130
DOI: 10.3760/cma.j.cn441530-20221124-00492 -
Cleveland Clinic Quarterly Jan 1969
Topics: Female; Humans; Pelvic Exenteration; Pelvic Neoplasms
PubMed: 5766523
DOI: 10.3949/ccjm.36.1.1 -
Gynecologic Oncology Jan 2012To evaluate the outcomes observed with pelvic exenteration with curative intent for recurrent uterine malignancies in the modern era.
OBJECTIVE
To evaluate the outcomes observed with pelvic exenteration with curative intent for recurrent uterine malignancies in the modern era.
METHODS
We reviewed the records of all patients who underwent this procedure at our institution between 1/1997 and 03/2011. Postoperative complications up to 90 days after surgery were analyzed and graded as per our institution grading system. Survivals were estimated using the Kaplan-Meier method.
RESULTS
During the study period, 21 patients were identified. Median age at the time of exenteration was 57 years (range, 36-75). Median tumor size was 6 cm (range, microscopic - 14.5). Tumor histology was: endometrioid, 10 cases; mixed, serous, and carcinosarcoma, 7 cases; and sarcomas, 4 cases. The type of exenteration was: total, 14 cases; anterior, 6 cases and posterior, 1 case. There were no intra- or postoperative mortalities. Seven patients (33%) developed at least one grade 2 complication, and 10 patients (48%) developed at least one grade 3 complication. Five (24%) patients had to be re-operated on in the first 90 days post surgery. The median follow up time after exenteration was 39 months (range, 5-112). The 5-year survival of the entire cohort was 40% (95% CI: 18-63). An improved survival was observed in patients with endometrioid tumors and sarcomas (5-year survival rates of 50% and 66%, respectively). The presence of pelvic sidewall involvement and/or hydronephrosis did not negatively affect survival.
CONCLUSION
Pelvic exenteration for recurrent uterine malignancies can be associated with long-term survival in properly selected patients. A high rate of postoperative complications remains a hallmark of this procedure and should be discussed carefully with patients facing this decision.
Topics: Adult; Aged; Female; Humans; Middle Aged; Neoplasm Recurrence, Local; Pelvic Exenteration; Retrospective Studies; Survival Rate; Treatment Outcome; Uterine Neoplasms
PubMed: 22014627
DOI: 10.1016/j.ygyno.2011.09.031