Clinical outcomes of pelvic exenteration for gynecologic malignancies

The aim of this study was to analyze morbidity and survival after pelvic exenteration for gynecologic malignancies and evaluate prognostic factors influencing postoperative outcome. We retrospectively reviewed all patients who underwent a pelvic exenteration at the departments of gynecologic oncolog...

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Bibliographic Details
Published in:	Gynecologic oncology Vol. 171; pp. 114 - 120
Main Authors:	Moolenaar, L.R., van Rangelrooij, L.E., van Poelgeest, M.I.E., van Beurden, M., van Driel, W.J., van Lonkhuijzen, L.R.C.W., Mom, C.H., Zaal, A.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-04-2023
Subjects:	Female Female genital neoplasms Genital Neoplasms, Female Humans Margins of Excision Morbidity Neoplasm Recurrence, Local - pathology Pelvic exenteration Pelvic Exenteration - adverse effects Pelvic Exenteration - methods Retrospective Studies Survival rate Uterine Cervical Neoplasms - pathology Pelvic exenteration Female genital neoplasms Survival rate Morbidity
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Summary:	The aim of this study was to analyze morbidity and survival after pelvic exenteration for gynecologic malignancies and evaluate prognostic factors influencing postoperative outcome. We retrospectively reviewed all patients who underwent a pelvic exenteration at the departments of gynecologic oncology of three tertiary care centers in the Netherlands, the Leiden University Medical Centre, the Amsterdam University Medical Centre, and the Netherlands Cancer Institute, during a 20-year period. We determined postoperative morbidity, 2- and 5-year overall survival (OS) and 2- and 5-year progression free survival (PFS), and investigated parameters influencing these outcomes. A total of 90 patients were included. The most common primary tumor was cervical cancer (n = 39, 43.3%). We observed at least one complication in 83 patients (92%). Major complications were seen in 55 patients (61%). Irradiated patients had a higher risk of developing a major complication. Sixty-two (68.9%) required ≥1 readmission. Re-operation was required in 40 patients (44.4%). Median OS was 25 months and median PFS was 14 months. The 2-year OS rate was 51.1% and the 2-year PFS rate was 41.5%. Tumor size, resection margins and pelvic sidewall involvement had a negative impact on OS (HR = 2.159, HR = 2.376, and HR = 1.200, respectively). Positive resection margins and pelvic sidewall involvement resulted in decreased PFS (HR = 2.567 and HR = 3.969, respectively). Postoperative complications after pelvic exenteration for gynecologic malignancies are common, especially in irradiated patients. In this study, a 2-year OS rate of 51.1% was observed. Positive resections margins, tumor size, and pelvic sidewall involvement were related to poor survival outcomes. Adequate selection of patients who will benefit from pelvic exenteration is important. •Pelvic exenteration is a rare surgical procedure with a 2-year OS rate of 51.1%.•Postoperative complications after pelvic exenteration are common, especially in irradiated patients.•Positive resections margins, tumor size, and pelvic sidewall involvement are related to poor survival outcomes.•Adequate selection of patients who will benefit from pelvic exenteration is of utmost importance.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0090-8258 1095-6859
DOI:	10.1016/j.ygyno.2023.02.010