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European Journal of Surgical Oncology :... Dec 2019To examine the changes in exenterative surgery over three decades analysing oncological outcomes and whether changes in surgical approach have led to improved patient...
OBJECTIVE
To examine the changes in exenterative surgery over three decades analysing oncological outcomes and whether changes in surgical approach have led to improved patient outcomes.
BACKGROUND
Advances in surgical technology, perioperative care and pattern of disease recurrence have coincided with an evolutionary change in exenterative surgery.
METHODS
A review of a prospectively maintained databases of pelvic exenteration surgery from 1988 to 2018 at two high volume specialised institutions. The total cohort was divided into three major time points (1988-2004, 2005-2010 and 2011 to 2018) to allow comparative analysis. Primary endpoints were overall survival in primary and recurrent disease at each time point. Secondary endpoints included anastomotic leak, blood transfusion, ileus, wound infection rates and evolution of case complexity. Data were analysed using R with a p < 0.05 considered significant.
RESULTS
Six hundred and seventy patients underwent exenterative surgery. In 2011-2018 there was an increase in resection of recurrent malignancy with a continuous increase in GI malignancies resected over each time period(p < 0.001,<0.01) and a reduction in gynaecological malignancy(p < 0.001). A significant increase in sacrectomy, pelvic sidewall resection and ileal conduit reconstruction was observed (p < 0.01,<0.001).In 2005-2010 patients had increased rates of ileus and anastomotic leak(p < 0.05). Patients undergoing resection for primary disease had improved overall survival at time points 1988-2004 and 2011-2018 compared to those with recurrent disease(p = 0.007,<0.001). Overall survival was significantly improved in patients with primary versus recurrent disease(p = 0.022).
CONCLUSION
There has been a significant improvement in survival in patients undergoing pelvic exenteration surgery from primary disease. Case complexity has increased without significant morbidity.
Topics: Adult; Aged; Aged, 80 and over; Digestive System Neoplasms; Endpoint Determination; Female; Humans; Male; Middle Aged; Pelvic Exenteration; Retrospective Studies; Survival Rate; Urogenital Neoplasms
PubMed: 31303376
DOI: 10.1016/j.ejso.2019.07.015 -
International Journal of Gynecological... Apr 2020
Topics: Cytoreduction Surgical Procedures; Female; Humans; Middle Aged; Ovarian Neoplasms; Ovariectomy; Pelvic Exenteration; Peritoneum
PubMed: 31911535
DOI: 10.1136/ijgc-2019-000984 -
ANZ Journal of Surgery Nov 2017Recurrent rectal cancer affects a significant group of patients with no current consensus on management. This study investigated patients' quality of life (QoL) in the...
BACKGROUND
Recurrent rectal cancer affects a significant group of patients with no current consensus on management. This study investigated patients' quality of life (QoL) in the 12 months after pelvic exenteration.
METHOD
Prospective cohort study with clinical and QoL data collected at baseline and 1, 3, 6, 9 and 12 months. QoL trajectories were modelled over 12 months from date of discharge using linear mixed models.
RESULTS
Of 117 patients, 93 underwent pelvic exenteration surgery, 24 did not. Thirty-day mortality was nil for both groups. For patients who had surgery, 15 (16%) died within 12 months of surgery compared with nine (38%) of the non-surgery group. Baseline QoL scores were highly variable. The non-exenteration patients' QoL gradually declined over 12 months while exenteration patients declined then recovered. Patients with high baseline QoL scores remained high, and those with low baseline QoL remained low. Baseline QoL score, gender and bony resection were significant predictors of QoL score at 12 months.
CONCLUSION
Baseline QoL is a significant, independent predictor of patients' QoL after pelvic exenteration for recurrent rectal cancer.
Topics: Australia; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Pelvic Exenteration; Predictive Value of Tests; Prospective Studies; Quality of Life; Rectal Neoplasms; Treatment Outcome
PubMed: 26687437
DOI: 10.1111/ans.13419 -
Diseases of the Colon and Rectum May 2018
Topics: Anal Canal; Humans; Neoplasm Grading; Pelvic Exenteration; Rectal Neoplasms; Transanal Endoscopic Surgery
PubMed: 29578917
DOI: 10.1097/DCR.0000000000001031 -
Texas Medicine Aug 1966
Topics: Adult; Female; Humans; Pelvic Exenteration
PubMed: 5946336
DOI: No ID Found -
Akusherstvo I Ginekologiia 2015Pelvic exenteration is an operative method for one-moment removal of pelvic organs, including reproductive tract, bladder and rectosidgmoid. It most common indicated in...
Pelvic exenteration is an operative method for one-moment removal of pelvic organs, including reproductive tract, bladder and rectosidgmoid. It most common indicated in gynecologic oncology for treatment of locally advanced cancer or recidive with central location. Pelvic exenteration can be used for healing of patients with genital cancer. Frequency of serious complications can reach 50%, that emphasizes the need of careful discuss of risks and benefits with the patients who are indicated for that kind of operation. For the period 2004-2012 common 46 exenterations are performed at FSHOG "St. Sofia", form which 9 are total (TE), 14 anterior (AE), 7 posterior (PE), 16 modified posterior exenterations (MPE). Average operative time is 459 min (237-620 min), depending on the type of operation. Average blood loss is 1200 ml (800-2500 ml). Report of the complications shows that eight patients have had 1-st degree complication.
Topics: Blood Loss, Surgical; Female; Genital Neoplasms, Female; Humans; Operative Time; Pelvic Exenteration; Postoperative Complications
PubMed: 26863791
DOI: No ID Found -
European Journal of Surgical Oncology :... Mar 2023Early recurrences and deaths after a morbid procedure like pelvic exenteration are devastating events. The present study aimed at determining the incidence and...
INTRODUCTION
Early recurrences and deaths after a morbid procedure like pelvic exenteration are devastating events. The present study aimed at determining the incidence and predictors of futile pelvic exenterations.
METHODS
Consecutive pelvic exenterations for advanced and recurrent rectal adenocarcinomas operated between January 2013 and January 2021 were included with a minimum of six months follow-up. Futility of exenteration was defined as recurrence or death within six months of operation. Multivariate logistic regression was used to define predictors of futility.
RESULTS
Two-hundred eighty-five patients were included and 61 patients (21.4%) had a futile resection. Poorly differentiated (or signet) histology, presence of lateral pelvic nodes, M1 disease, and the need for pelvic bone resections predicted a futile resection. The probability of futility was 10%, 20%, 35-40%, 55-60%, and >75% when none, one, two, three, and all four of the predictors were present. The model was able to correctly predict futility in 70% of the cases suggesting moderate discrimination, and showed good calibration.
CONCLUSIONS
Futile pelvic exenterations were observed in one-fifth of patients. Four strong predictors of futility were identified. The risk of early failures was additive when combination of these adverse features was present, and can be used for patient selection and prognostication.
Topics: Humans; Pelvic Exenteration; Medical Futility; Retrospective Studies; Neoplasm Recurrence, Local; Rectal Neoplasms
PubMed: 36357296
DOI: 10.1016/j.ejso.2022.10.022 -
Application of robot-assisted laparoscopic pelvic exenteration in treating gynecologic malignancies.Chinese Medical Journal Apr 2019
Topics: Female; Genital Neoplasms, Female; Humans; Laparoscopy; Pelvic Exenteration; Postoperative Complications; Robotic Surgical Procedures
PubMed: 30958440
DOI: 10.1097/CM9.0000000000000202 -
BJS Open Aug 2019Pelvic exenteration for locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) is technically challenging but increasingly performed in...
BACKGROUND
Pelvic exenteration for locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) is technically challenging but increasingly performed in specialist centres. The aim of this study was to compare outcomes of exenteration over time.
METHODS
This was a multicentre retrospective study of patients who underwent exenteration for LARC and LRRC between 2004 and 2015. Surgical outcomes, including rate of bone resection, flap reconstruction, margin status and transfusion rates, were examined. Outcomes between higher- and lower-volume centres were also evaluated.
RESULTS
Some 2472 patients underwent pelvic exenteration for LARC and LRRC across 26 institutions. For LARC, rates of bone resection or flap reconstruction increased from 2004 to 2015, from 3·5 to 12·8 per cent, and from 12·0 to 29·4 per cent respectively. Fewer units of intraoperative blood were transfused over this interval (median 4 to 2 units; = 0·040). Subgroup analysis showed that bone resection and flap reconstruction rates increased in lower- and higher-volume centres. R0 resection rates significantly increased in low-volume centres but not in high-volume centres over time (low-volume: from 62·5 to 80·0 per cent, = 0·001; high-volume: from 83·5 to 88·4 per cent, = 0·660). For LRRC, no significant trends over time were observed for bone resection or flap reconstruction rates. The median number of units of intraoperative blood transfused decreased from 5 to 2·5 units ( < 0·001). R0 resection rates did not increase in either low-volume (from 51·7 to 60·4 per cent; = 0·610) or higher-volume (from 48·6 to 65·5 per cent; = 0·100) centres. No significant differences in length of hospital stay, 30-day complication, reintervention or mortality rates were observed over time.
CONCLUSION
Radical resection, bone resection and flap reconstruction rates were performed more frequently over time, while transfusion requirements decreased.
Topics: Aged; Blood Transfusion; Female; Humans; Length of Stay; Male; Middle Aged; Neoplasm Recurrence, Local; Pelvic Exenteration; Postoperative Complications; Rectal Neoplasms; Rectum; Retrospective Studies; Surgical Flaps; Treatment Outcome
PubMed: 31388644
DOI: 10.1002/bjs5.50153 -
International Journal of Gynecological... Aug 2021
Topics: Female; Humans; Pelvic Exenteration; Prostheses and Implants; Plastic Surgery Procedures; Vaginal Neoplasms
PubMed: 33649158
DOI: 10.1136/ijgc-2020-002304