Morbidity After Pelvic Exenteration for Gynecological Malignancies: A Retrospective Multicentric Study of 230 Patients

Abstract

Although an important effort for surgeons and for patients, PE remains a therapeutic option with an acceptable complication rate and postoperative mortality. A strict selection of patients is mandatory to reach adequate surgical and oncologic outcomes.

Pelvic Exenteration in Gynecologic Cancer: La Paz University Hospital Experience

“…Some studies have demonstrated that after PE, patients 65 years and older had similar complication and survival rates to those of younger patients. 19,23,24 In our series, 2 patients were older than 65 years, both of them were 73 years old at the time of PE, one died in the postoperative period, and the other presented with no severe complications.…”

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

“…8 However, in this descriptive analysis, the authors did not investigate factors predicting the occurrence of morbidity. However, few researches clearly underlined that type of radiation therapy, time between radiation therapy and treatment, and other patients' constitutional variable impact on patients outcomes.…”

“…6,7 However, pelvic exenteration is associated with severe morbidity and a nonnegligible risk of mortality. 8 Moreover, it has been reported that postoperative sequelae have a profound impact on patients' quality of life. 9 Even if patient selection, enhanced perioperative care, and technical and technological improvements have reduced morbidity and mortality rate dramatically in the last years, morbidity rate still remained very high (ranging between 40% and 70%) in the more recent series.…”

Role of MR Imaging and FDG PET/CT in Selection and Follow-up of Patients Treated with Pelvic Exenteration for Gynecologic Malignancies

“…Recently published data suggests that the cornerstones of long-term survival after salvage (curative intent) PE (regardless of exact exenterative procedure type) are the absence of nodal and systemic metastases at preoperative evaluation and negative histopathologic margins at excision (1,(5)(6)(7)(17)(18)(19)(20)(21). Thus, the 5-year survival rate is around 50% for patients with negative margins but declines to less than 10% when the margins are positive (1,20).…”

“…Factors known to adversely affect operative morbidity are the complexity of pelvic reconstruction and prior radiation therapy leading to impaired healing and immunologic response (17). In the acute postoperative setting, the most common complications seen at imaging are hematoma, abscess, lymphocele, wound dehiscence, colorectal anastomotic insufficiency (abscess, fistula, peritonitis, bowel obstruction), urinary complications (hydronephrosis, urine leak, urinoma, anastomotic breakdown), and myocutaneous flap complications (flap necrosis or abscess; donor site dehiscence, abscess, or seroma) (1).…”