Factors Predictive of 90-Day Morbidity, Readmission, and Costs in Patients Undergoing Pelvic Exenteration

Bogani, Giorgio; Signorelli, Mauro; Ditto, Antonino; Martinelli, Fabio; Casarin, Jvan; Mosca, Lavinia; Maggiore, Umberto Leone Roberti; Chiappa, Valentina; Lorusso, Domenica; Raspagliesi, Francesco

doi:10.1097/igc.0000000000001251

Cited by 12 publications

(12 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

Section: Discussionsupporting

confidence: 92%

“…In contrast, neither preoperative anemia nor preoperative hypoalbuminemia was found to be a predictive factor for postoperative morbidity. This is in line with recent reports where pelvic exenteration was performed for recurrent gynecological malignancies [18,19]. With regard to factors that determine the long-term outcome of patients undergoing a PE, advanced age as well as an ASA III status was associated with an elevated risk of lower OS but not RFS.…”

Section: Discussionsupporting

confidence: 89%

See 1 more Smart Citation

Pelvic exenteration for colorectal and non-colorectal cancer: a comparison of perioperative and oncological outcome

Bogner

Fritzmann

Müssle

et al. 2021

Int J Colorectal Dis

View full text Add to dashboard Cite

Background Pelvic exenteration (PE) is the only option for long-term cure of advanced cancer originating from different types of tumor or recurrent disease in the lower pelvis. The aim was to show differences between colorectal and non-colorectal cancer in survival and postoperative morbidity. Methods Retrospective data of 63 patients treated with total pelvic exenteration between 2013 and 2018 are reported. Pre-, intra-, and postoperative parameters, survival data, and risk factors for complications were analyzed. Results A total of 57.2% (n = 37) of the patients had colorectal cancer, 22.3% had gynecological malignancies (vulvar (n = 6) or cervical (n = 8) cancer), 11.1% (n = 7) had anal cancer, and 9.5% had other primary tumors. A total of 30.2% (n = 19) underwent PE for a primary tumor and 69.8% (n = 44) for recurrent cancer. The 30-day in-hospital mortality was 0%. Neoadjuvant treatment was administered to 65.1% (n = 41) of the patients and correlated significantly with postoperative complications (odds ratio 4.441; 95% CI: 1.375–14.342, P > 0.05). R0, R1, R2, and Rx resections were achieved in 65.1%, 19%, 1.6%, and 14.3% of the patients, respectively. In patients undergoing R0 resection, 2-year OS and RFS were 73.2% and 52.4%, respectively. Resection status was a significant risk factor for recurrence-free and overall survival (OS) in univariate analysis. Multivariate analysis revealed age (P = 0.021), ASA ≥ 3 (P = 0.005), high blood loss (P = 0.028), low preoperative hemoglobin level (P < 0.001), nodal positivity (P < 0.001), and surgical complications (P = 0.003) as independent risk factors for OS. Conclusion Pelvic exenteration is a procedure with high morbidity rates but remains the only curative option for advanced or recurrent colorectal and non-colorectal cancer in the pelvis.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 89%

Pelvic exenteration for colorectal and non-colorectal cancer: a comparison of perioperative and oncological outcome

Bogner

Fritzmann

Müssle

et al. 2021

Int J Colorectal Dis

View full text Add to dashboard Cite

show abstract

“…The ongoing retrospective ABRAX (ABandoning RAd hyst in cerviX cancer) trial is investigating oncological outcomes after completing or abandoning (radical) hysterectomy in patients with cervical cancer and intra-operative detection of positive lymph node(s) 15. Fourth, it is possible that further salvage surgery might play a role in patients with loco-regional recurrent disease 16–18…”

Section: Discussionmentioning

confidence: 99%

Burden of lymphatic disease predicts efficacy of adjuvant radiation and chemotherapy in FIGO 2018 stage IIICp cervical cancer

Bogani

Vinti

Murgia

et al. 2019

Int J Gynecol Cancer

Self Cite

View full text Add to dashboard Cite

ObjectiveNodal involvement is one of the most important prognostic factors in cervical cancer patients. We aimed to assess the prognostic role in relation to the burden of nodal disease in stage IIICp cervical cancer.MethodsData on all consecutive patients diagnosed with cervical cancer undergoing primary surgery (radical hysterectomy plus lymphadenectomy) or neoadjuvant chemotherapy followed by radical hysterectomy plus lymphadenectomy, between January 1980 and December 2017, were collected in a dedicated database. Exclusion criteria were: (1) consent withdrawal; (2) synchronous malignancies (within 5 years). Survival outcomes were assessed using Kaplan-Meier and Cox models.ResultsOverall, 177 (14.1%) of 1257 patients with cervical cancer were diagnosed with positive lymph nodes. After a median follow-up of 58 (range 4–175) months, 66 (37.3%) and 37 (20.9%) patients developed recurrent disease and died of disease, respectively. Via multivariate analysis, positive para-aortic nodes (HR 2.62, 95% CI 1.12 to 6.11; p=0.025) and the number of positive nodes (HR 1.06, 95% CI 1.02 to 1.11; p=0.002) correlated with worse disease-free survival. Furthermore, the number of positive nodes (HR 1.06, 95% CI 1.01 to 1.12; p=0.021) correlated with worse overall survival. Number of positive nodes (1, 2 or ≥3) strongly correlated with both disease-free survival (p<0.001, log-rank test) and overall survival (p=0.001, log-rank test). Focusing on patients receiving adjuvant radiation and chemotherapy, the number of positive lymph nodes was associated with response to treatment (p<0.001). Median disease-free survival was 100, 42, and 12 months for patients with one, two, or three or more positive lymph node(s), respectively (p<0.001, log-rank test).ConclusionsIn stage IIICp cervical cancer, adjuvant radiation and chemotherapy provides adequate overall survival in patients diagnosed with only one metastatic node, while survival outcomes are poor in patients with two or more metastatic nodes. This highlights the need for innovative treatments in patients with a high burden of lymphatic disease.

show abstract

“…La colecistectomía laparoscópica es uno de los procedimientos más frecuentes en el ámbito de la cirugía debido a la alta prevalencia de patología biliar. Esto hace que el estudio de los reingresos asociados a este procedimiento sea piedra angular para poder reducir los costes asociados 7 .…”

Section: Discussionunclassified

Readmissions due to biliar complications in patients with acude cholecystitis conservatively treated due to concomitant biliar duct obstruction suspicion: a bicentric study of an usual issue

et al. 2022

View full text Add to dashboard Cite

Resumen Introducción: La colecistectomía laparoscópica es el tratamiento gold standard en la colecistitis aquda litiásica, si bien su manejo cuando existe coledocolitiasis concomitante es controvertido. Objetivos: Evaluar los reingresos por complicaciones biliares en pacientes con colecistitis aguda tratados de forma conservadora por sospecha de coledocolitiasis concomitante. Material y métodos: Estudio retrospectivo bicéntrico. Recogida de datos: Junio 2015 – Octubre 2017. Diagnóstico de colecistitis aguda según criterios de Guía de Tokyo y alto riesgo de coledocolitiasis según American Asociation for Gastroenterology. Resultados: Se incluyeron 137 pacientes de los cuales la colecistectomía se pospuso en 86 (62,8%) por sospecha de coledocolitiasis concomitante. Dicha obstrucción de la vía biliar se confirmó en el 42,3% de los casos. Cuando la vía biliar no está dilatada en la ecografía el valor de bilirrubina como predictor de coledocolitiasis fue 4,5mg/dL. La tasa de reingresos en paciente no intervenidos fue del 23,3%. Conclusiones: el tratamiento conservador de la colecistitis aguda por sospecha de una coledocolitiasis concomitante hace que se demore la colecistectomía. Dicha demora supone un aumento de los reingresos hospitalarios por complicaciones biliares.

show abstract

Factors Predictive of 90-Day Morbidity, Readmission, and Costs in Patients Undergoing Pelvic Exenteration

Abstract: Preoperative patient selection is a key point for the reduction of postoperative complications after pelvic exenteration. Further prospective studies are warranted to improve patient selection.

Cited by 12 publications

References 23 publications

Pelvic exenteration for colorectal and non-colorectal cancer: a comparison of perioperative and oncological outcome

Pelvic exenteration for colorectal and non-colorectal cancer: a comparison of perioperative and oncological outcome

Burden of lymphatic disease predicts efficacy of adjuvant radiation and chemotherapy in FIGO 2018 stage IIICp cervical cancer

Readmissions due to biliar complications in patients with acude cholecystitis conservatively treated due to concomitant biliar duct obstruction suspicion: a bicentric study of an usual issue

Contact Info

Product

Resources

About