Pelvic exenteration for gynecologic malignancies: The experience of a tertiary center from Greece.
Adult
Aged
Aged, 80 and over
Female
Genital Neoplasms, Female
/ mortality
Greece
Humans
Kaplan-Meier Estimate
Margins of Excision
Middle Aged
Neoplasm Recurrence, Local
/ epidemiology
Pelvic Exenteration
/ adverse effects
Postoperative Complications
/ epidemiology
Proportional Hazards Models
Retrospective Studies
Survival Rate
Treatment Outcome
Exenteration
Gynecologic malignancy
Gynecological cancer
Survival
Journal
Surgical oncology
ISSN: 1879-3320
Titre abrégé: Surg Oncol
Pays: Netherlands
ID NLM: 9208188
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
received:
03
11
2021
revised:
15
12
2021
accepted:
28
12
2021
pubmed:
23
1
2022
medline:
17
3
2022
entrez:
22
1
2022
Statut:
ppublish
Résumé
Pelvic exenteration is an ultraradical procedure that is performed for locally advanced pelvic malignancies. Despite its rarity, the rates of the procedure increase during the last years due to the gain of surgical expertise. Data on survival rates remain; however, scarce in the literature. We retrospectively reviewed the records of all patients who underwent exenterative procedures for advanced gynecologic malignancies between 2006 and 2020. Major and minor perioperative complications were documented according to the Clavien-Dindo classification only when they occurred during a time limit of 30 days from the operation. Cox regression analysis and Kaplan-Meier survival curves were used for the analysis of survival outcomes. Overall, we identified 138 patients who were offered a pelvic exenteration procedure that were followed up for a median of 42 months (range 6-60 months). Seventy-five patients recurred (54.3%) during the follow-up period within 35.04 months (95% CI 31.01, 39.07 months). After examining several potential factors that might influence survival rates, we observed that only patients with positive margins had increased risk of recurrence (HR 1.66, 95%CI 1.10, 2.56 p = .016), although this was not associated with a decrease in overall survival. Overall survival outcomes were available for 112 patients of whom 62 died (55.4%) within 38.84 months (95% CI 35.02, 42.67). Major complications were detected in 21 patients. Reoperation was required in 18 patients. Anastomotic leakage was observed in 7 cases (5%) of whom 4 patients required reoperation. In summary, the findings of our study suggest that women undergoing pelvic exenteration for gynecologic malignancies have a significant survival probability that is accompanied by acceptable rates of operative morbidity.
Sections du résumé
BACKGROUND
BACKGROUND
Pelvic exenteration is an ultraradical procedure that is performed for locally advanced pelvic malignancies. Despite its rarity, the rates of the procedure increase during the last years due to the gain of surgical expertise. Data on survival rates remain; however, scarce in the literature.
METHODS
METHODS
We retrospectively reviewed the records of all patients who underwent exenterative procedures for advanced gynecologic malignancies between 2006 and 2020. Major and minor perioperative complications were documented according to the Clavien-Dindo classification only when they occurred during a time limit of 30 days from the operation. Cox regression analysis and Kaplan-Meier survival curves were used for the analysis of survival outcomes.
RESULTS
RESULTS
Overall, we identified 138 patients who were offered a pelvic exenteration procedure that were followed up for a median of 42 months (range 6-60 months). Seventy-five patients recurred (54.3%) during the follow-up period within 35.04 months (95% CI 31.01, 39.07 months). After examining several potential factors that might influence survival rates, we observed that only patients with positive margins had increased risk of recurrence (HR 1.66, 95%CI 1.10, 2.56 p = .016), although this was not associated with a decrease in overall survival. Overall survival outcomes were available for 112 patients of whom 62 died (55.4%) within 38.84 months (95% CI 35.02, 42.67). Major complications were detected in 21 patients. Reoperation was required in 18 patients. Anastomotic leakage was observed in 7 cases (5%) of whom 4 patients required reoperation.
CONCLUSION
CONCLUSIONS
In summary, the findings of our study suggest that women undergoing pelvic exenteration for gynecologic malignancies have a significant survival probability that is accompanied by acceptable rates of operative morbidity.
Identifiants
pubmed: 35065392
pii: S0960-7404(21)00191-2
doi: 10.1016/j.suronc.2021.101702
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
101702Informations de copyright
Copyright © 2021. Published by Elsevier Ltd.