Minimally invasive pelvic exenteration for gynaecological malignancy: A single-centre case series and review of the literature

Karkia, Rebecca; Tailor, Anil; Ellis, Patricia; Madhuri, Thumuluru Kavitha; Scala, Arianna; Read, James; Perry, Matthew; Patil, Kishor; Blackburn, Adam; Butler‐Manuel, Simon; Chatterjee, Jayanta

doi:10.1016/j.ejogrb.2022.05.003

Cited by 9 publications

(5 citation statements)

References 29 publications

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“…Regarding the incidence of intra-and postoperative complications, our small sample size did not allow us to draw definitive conclusions or to perform a comparison between the two approaches. However, in our series of minimally invasive surgeries, we observed a low incidence of major complications similar to the findings reported recently by some authors (76)(77)(78). In particular, a retrospective multicenter analysis carried out by Bizzarri et al (76) in 23 patients with primary or central recurrent/persistent gynecologic cancer who underwent pelvic exenteration by laparoscopic or robotic approach showed that minimally invasive pelvic exenteration was feasible with low rate of intraoperative and postoperative complications.…”

Section: Operative Outcomes Of Pelvic Exenteration Using Different Su...supporting

confidence: 90%

Survival as a clinical outcome and its spiritual significance in a cohort of patients with advanced central pelvic neoplastic disease undergoing total pelvic evisceration: a poorly debated issue

Macciò¹,

Sanna²,

Piras³

et al. 2023

Front. Med.

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BackgroundPatients with either treatment-resistant or relapsing advanced central pelvic neoplastic disease present with a condition responsible for debilitating symptoms and consequently poor quality of life (QoL). For these patients, therapeutic strategies are very limited and total pelvic evisceration is the only option for relieving the symptoms and increasing survival. Of note, taking charge of these patients cannot be limited to increasing their lifespan but must also be aimed at improving the clinical, psychological, and spiritual conditions. This study aimed to prospectively evaluate the improvement in survival and QoL, focusing on spiritual wellbeing (SWB), in patients with poor life expectancy who underwent total pelvic evisceration for advanced gynecological cancers at our center.Patients and methodsThe QoL and SWB were assessed using the European Organisation for Research and Treatment of Cancer QoL questionnaire (EORTC QLQ-C30), EORTC QLQ-SWB32, and SWB scale, which were repeatedly administered: 30 days before surgery, 7 days after the procedure, 1 and 3 months after surgery, and then every 3 months until death or the last follow-up assessment. Operative outcomes (blood loss, operative time, hospitalization, and incidence of complications) were evaluated as secondary endpoints. The patients and their families were included in a dedicated psycho-oncological and spiritual support protocol, which was managed by specifically trained and specialized personnel who accompanied them during all phases of the study.ResultsA total of 20 consecutive patients from 2017 to 2022 were included in this study. Of these patients, 7 underwent total pelvic evisceration by laparotomy and 13 underwent laparoscopy. The median survival was 24 months (range: 1–61 months). After a median follow-up of 24 months, 16 (80%) and 10 patients (50%) were alive at 1 year and 2 years after surgery, respectively. The EORTC-QLQ-C30 scores significantly improved yet at 7 days and at 1, 3, 6, and 12 months, as compared with the preoperative values. In particular, an early improvement in pain, overall QoL, and physical and emotional functions was observed. With respect to the SWB, the global SWB item score of the EORTC QLQ-SWB32 questionnaire significantly increased after 1 month and 3 months, as compared with preoperative values (p = 0.0153 and p = 0.0018, respectively), and remained stable thereafter. The mean SWB scale score was 53.3, with a sense of low overall SWB in 10 patients, a sense of moderate SWB in eight patients, and a sense of high SWB in two patients. The SWB scale score significantly increased after 7 days, 1 month, and 3 months, as compared with the preoperative value (p = 0202, p = 0.0171, and p = 0.0255, respectively), and remained stable thereafter.ConclusionTotal pelvic evisceration is a valid approach for improving both survival and QoL in selected patients with advanced pelvic neoplasms and poor life expectancy. Our results particularly underline the importance of accompanying the patients and their families during the journey with dedicated psychological and spiritual support protocols.

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Section: Operative Outcomes Of Pelvic Exenteration Using Different Su...supporting

confidence: 90%

Survival as a clinical outcome and its spiritual significance in a cohort of patients with advanced central pelvic neoplastic disease undergoing total pelvic evisceration: a poorly debated issue

Macciò¹,

Sanna²,

Piras³

et al. 2023

Front. Med.

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“… 63 0 2 0 1 2 Brown et al [ 96 ] 2021 Australia Case Series Colorectal Recurrent Open 2 11.5 (Range: 2–18) 0 0 0 0 Kanao et al [ 97 ] 2021 Japan Cohort Gynecological Recurrent MIPE 7 23.1 (Range: 8.7–39.0) 0 0 0 0 0 Nielsen et al [ 102 ] 2022 Denmark Cohort Misc. Both Open 195 23 (range: 0.5–72) 1 6 Rios-Doria et al [ 113 ] 2022 USA Cohort Gynecological Both Open 62 27.6 (range, 1.0–117.5) 0 0 Karkia et al [ 114 ] 202...…”

Section: Resultsmentioning

confidence: 99%

A systematic review and meta-analysis on mortality rate following total pelvic exenteration in cancer patients

Esmailzadeh,

Fakhari,

Saedi

et al. 2024

BMC Cancer

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Background Total pelvic exenteration (TPE), an en bloc resection is an ultraradical operation for malignancies, and refers to the removal of organs inside the pelvis, including female reproductive organs, lower urological organs and involved parts of the digestive system. The aim of this meta-analysis is to estimate the intra-operative mortality, in-hospital mortality, 30- and 90-day mortality rate and overall mortality rate (MR) following TPE in colorectal, gynecological, urological, and miscellaneous cancers. Methods This is a systematic review and meta-analysis in which three international databases including Medline through PubMed, Scopus and Web of Science on November 2023 were searched. To screen and select relevant studies, retrieved articles were entered into Endnote software. The required information was extracted from the full text of the retrieved articles by the authors. Effect measures in this study was the intra-operative, in-hospital, and 90-day and overall MR following TPE. All analyzes are performed using Stata software version 16 (Stata Corp, College Station, TX). Results In this systematic review, 1751 primary studies retrieved, of which 98 articles (5343 cases) entered into this systematic review. The overall mortality rate was 30.57% in colorectal cancers, 25.5% in gynecological cancers and 12.42% in Miscellaneous. The highest rate of mortality is related to the overall mortality rate of colorectal cancers. The MR in open surgeries was higher than in minimally invasive surgeries, and also in primary advanced cancers, it was higher than in recurrent cancers. Conclusion In conclusion, it can be said that performing TPE in a specialized surgical center with careful patient eligibility evaluation is a viable option for advanced malignancies of the pelvic organs.

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“…Although our experience is with straight-stick, the surgical time required for CPCR bodes well for the application of robotic surgery. A UK centre has already adopted this robotic approach for pelvic exenterations in the treatment gynecological oncology malignancies [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Organ-Sparing Central Pelvic Compartment Resection for the Treatment of Vulvo-Vaginal Melanomas

McGowan,

O’Carrigan,

Martins

et al. 2023

Melanoma Manag.

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Vulvo-vaginal melanomas are one of the rarest gynecological oncology diseases with a poor survival compared with other malignancies. The 5-year survival varies from 13% to 32.3%. Vulvo-vaginal melanomas involving the upper 2/3rds of the vagina are usually treated with total pelvic exenteration (TPE). TPE surgery carries a 50% risk of major complications and also morbidity associated with double stomas. Central pelvic compartment resection is a novel organ-sparing surgical approach entailing radical total laparoscopic hysterectomy, bilateral salpingo-oophrectomy, laparoscopic vaginectomy and vulvectomy to reduce morbidity compared with TPE. Permanent suprapubic catheters are used if there is urethral involvement but require quality of life studies to assess their long-term outcomes.

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Minimally invasive pelvic exenteration for gynaecological malignancy: A single-centre case series and review of the literature

Cited by 9 publications

References 29 publications

Survival as a clinical outcome and its spiritual significance in a cohort of patients with advanced central pelvic neoplastic disease undergoing total pelvic evisceration: a poorly debated issue

Survival as a clinical outcome and its spiritual significance in a cohort of patients with advanced central pelvic neoplastic disease undergoing total pelvic evisceration: a poorly debated issue

A systematic review and meta-analysis on mortality rate following total pelvic exenteration in cancer patients

Organ-Sparing Central Pelvic Compartment Resection for the Treatment of Vulvo-Vaginal Melanomas

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