Pelvic exenteration in gynecologic cancer: complications and oncological outcome

Abstract

Introduction: Pelvic exenteration (PE) is indicated in cases of unresponsive, recurrent pelvic cancer or for palliative intent. Despite the fact that the surgery is associated with a high rate of morbidity, it is currently the only real option that can effect a cure. Material and methods: Patients who underwent PE between January 2011 and July 2017 in our centre were retrospectively reviewed. Data related to surgery, complications and outcomes were recorded. Results: Twenty-three patients were included. PE was performed due to recurrent gynaecological cancer, persistence of disease and after first diagnosis in 19 (82%), 2 (9%) and 2 patients (9%), respectively. Total PE was performed in 15 cases (65%), followed by anterior PE in 5 cases (22%) and posterior PE in 3 cases (13%). Early grade II, III and IV complications occurred in 15 (65%), 5 (22%) and 2 patients (9%), respectively. No mortality was observed within 30 days. Medium-late grade II, III, IV and V complications occurred in 15 (65%), 11 (48%), 3 (13%) and 2 cases (9%), respectively. Two patients died after > 30-day period from surgery-related complications. The overall survival (OS) and disease-free survival (DFS) at 48 months after PE was 41.6% and 30.8% respectively. Conclusions: PE provides about a 40% 4-year survival chance in a selected group of patients. The earlycomplications rate and 30-day mortality were acceptable. Nevertheless, the medium-late complication grades II-V were 65, 48, 18 and 9%, respectively. We must focus on identifying those patients who could potentially benefit most from PE.

Comparison of postoperative complications and quality of life between patients undergoing continent versus non-continent urinary diversion after pelvic exenteration for gynecologic malignancies

“…Recently, Lago et al published a retrospective study including patients who underwent pelvic exenteration with incontinent urinary and/or digestive reconstruction for gynecologic malignancies, and found a rate of grade III–IV complications according to the Clavien-Dindo classification of 48%, in line with our results. In agreement with our study, they observed a similar rate of urinary and digestive complications (approximately 17% and 26%, respectively) 20. Four previous studies have compared the rate of complications between continent and incontinent urinary diversion in patients with gynecologic cancers.…”

Microbiological characteristics of early and late infectious complications following total pelvic exenteration due to cervical cancer recurrence—the significance of infections in long-term outcomes

“…Despite preoperative assessment, patients undergoing TPE are at higher risk for postoperative complications. Most studies reported approximately 44.0-80.0% prevalence of various postoperative complications after TPE [3][4][5][6][7][8], with infectious complications accounting for 10 to 23% [2,3]. However, in some studies, in a selected group of patients, infections were as high as 40-50.0% [6,9] as a result of overlapping of multiple risk factors.…”

Double-barrel wet colostomy after total pelvic exenteration

“…Urinary and fecal diversion is needed to restore normal function after total pelvic exenteration because of gynecological cancer. 1 In these patients, the Bricker procedure and end colostomy are often used for this purpose. Nevertheless, their use may lead to complications in patients with previous radiotherapy and may influence the ileum anastomosis.…”

“…During the postoperative period, several studies have demonstrated there is no statistically significant difference in the rate of postoperative complications such as stenosis of the uretero-intestinal anastomosis, obstructive nephropathy, formation of calculi in the conduit, urinary infections or electrolyte imbalances (Table 1). [1][2][3][4] The urine drains into a reservoir distal to the stoma; consequently, the mixture of fecal content with urine and the resultant Video article ascending pyelonephritis is greatly reduced. Furthermore, with adequate stoma care and regular change of collection appliances, peristomal dermatitis and other local skin complications can be avoided or easily controlled.…”

“…Urinary and fecal diversion is needed to restore normal function after total pelvic exenteration because of gynecological cancer 1. In these patients, the Bricker procedure and end colostomy are often used for this purpose.…”