Short‐term outcomes following development of a dedicated pelvic exenteration service in a tertiary centre

Abstract

Background: Pelvic exenteration surgery (PE) offers potentially curative resection for locally advanced malignancy but is associated with significant complexity and morbidity. Specialised teams are recommended to achieve optimal patient outcomes. This study aims to analyse short-term outcomes at a tertiary setting before and after creating a dedicated PE service. Methods: Patients undergoing PE between 2008 and October 2021 at the Royal Adelaide Hospital and St. Andrews Hospital in South Australia were included, with prospective data collection since June 2017. Patients operated on prior and post the creation of the PE service were compared via univariate analyses. Results: In total, 113 patients were included, with a significant increase in volume of cases post creation of the PE service, (n = 46 pre versus n = 67 post). There were significant differences in the type of neoadjuvant therapy and patient co-morbidity, with more advanced disease stage and a higher likelihood of bone involvement (P < 0.05) in the latter period. An increased proportion of patients had flap reconstruction (40.3 versus 33.9%, P = 0.010) as well as lateral lymph node dissection (13.4 versus 2.2%, P = 0.046). Despite this, perioperative outcomes such as urosepsis (11.9 versus 28.3%, P = 0.028) and Clavien-Dindo grade of complications grade improved. R0 resections were achieved in 93.9% of curative cases (93.9 versus 84.2%, P = 0.171). Conclusion:The development of a PE service significantly improved short term patient outcomes, despite the inclusion of patients with more advanced disease and comorbidity.

Establishing a state‐wide pelvic exenteration multidisciplinary team meeting in South Australia

“…Recognizing that the current data are collected from a 12-month period, the number of referrals to interstate centres has reduced from all three LHN's collectively. 1,17 This may reflect the presence of a surgeon from RPAH at the MDT but is also likely the result of progress and development in specialist expertise available within SA. A recent publication from the RAH exenteration unit has demonstrated that more complex operations are being performed on patients with more advanced disease and increased comorbidities without compromising patient outcomes.…”

“…A recent publication from the RAH exenteration unit has demonstrated that more complex operations are being performed on patients with more advanced disease and increased comorbidities without compromising patient outcomes. 17 While it is anticipated that interstate referrals may naturally decline over time with increased local experience, the need for better coordination is already recognized. Seizing the opportunity for better processes now has been a key element in addressing the increased demand for pelvic exenteration services in SA.…”

“…In parallel with this, a dedicated pelvic exenteration service was being established at the Royal Adelaide Hospital, with work progressing on this since 2017, and volumes of exenteration surgery being done locally increasing rapidly as the resource matured. 17 After a series of meetings between heads of the colorectal units of the four major metropolitan hospitals, and with the support of expert colleagues from interstate referral centres and the State-wide Cancer Clinical Network, Commission on Excellence and Innovation in Health, formation of the SA State-wide Pelvic Exenteration MDT meeting was proposed. The meeting was setup up in a virtual format on a monthly schedule.…”

“…This was further galvanized by a reduction in free movement of patients between states due to the Covid pandemic. In parallel with this, a dedicated pelvic exenteration service was being established at the Royal Adelaide Hospital, with work progressing on this since 2017, and volumes of exenteration surgery being done locally increasing rapidly as the resource matured 17 …”

Is preoperative sarcopenia associated with postoperative complications after pelvic exenteration surgery?

“…Patients who underwent PE for colorectal cancer, gynaecological malignancy, sarcoma, or benign disease between May 2008 and November 2022 at the Royal Adelaide Hospital and St. Andrews Private Hospital in South Australia were retrospectively identified from a prospectively maintained database set up for the PelvEx collaborative as previously reported [ 17 ]. All patients were scheduled for PE based on computed tomography (CT), positron emission tomography (PET), or magnetic resonance imaging (MRI), and multi-disciplinary team (MDT) discussion.…”