Complications and recurrence after pelvic exenteration for gynecologic malignancies: Analysis of surgical complications from the COREPEX study.
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Bizzarri Nicolò, Querleu Denis, Ricotta Giulio, Giannarelli Diana, Cãpîlna Mihai Emil, Domingo Santiago, Chiantera Vito, Akıllı Hüseyin, Cibula David, Novák Zoltan, Zach Diana, Miranda Andrea, Korompelis Porfyrios, Chiva Luis, Zapardiel Ignacio, Lampe Björn, Svintsitskyi Valentyn, Matylevich Olga, van Ramshorst Gabrielle H, Taskiran Cagatay, Demirkıran Fuat, Lengyel Tibor, Vizzielli Giuseppe, Loverro Matteo, Ferron Gwenael, Martinez Alejandra, Gauroy Elodie, Ladanyi Emmanuel, Kiss Leo Szilard, Lago Victor, Montesinos-Albert Manel, Di Donna Mariano Catello, Cucinella Giuseppe, Ayhan Ali, Slama Jiri, Rosta Viktória, Salehi Sahar, Muallem Mustafa Zelal, Kucukmetin Ali, Scambia Giovanni
Аннотация
METHODS: This was a retrospective, multi-center, international study conducted in tertiary referral centers for gynecologic oncology. The inclusion criteria included cervical, vaginal, vulvar, or endometrial cancer; anterior/total pelvic exenteration performed between January 2005 and March 2023; curative/palliative intent; with or without laterally extended endopelvic/pelvic resection. Logistic regression adjusted for co-variables and a score predictive of severe post-operative complications based on the multi-variable analysis were developed.
RESULTS: A total of 862 patients were included. Seven patients (0.8%) had severe intra-operative complications, and no patient experienced intra-operative death. A total of 225 patients (26.1%) had severe early post-operative complications and 27 (3.1%) died within 30 days. The most frequent severe early post-operative complications were pelvic abscess/collection (23.4%) and urostomy leak/fistula (13.4%). A total of 87 patients (10.1%) had severe late post-operative complications, and 16 patients (1.8%) died between 31 and 180 days. The most frequent severe late post-operative complications were pelvic abscess/collection (21.6%) and benign ureteric stricture (13.5%). Risk factors independently associated with severe early and late post-operative complications were no previous recurrences, American Society of Anesthesiologists score >1, total pelvic exenteration, infra-levator pelvic exenteration, laterally extended endopelvic/pelvic resection; and infra-levator pelvic exenteration and laterally extended endopelvic/pelvic resection, respectively. The COREPEX predictive score identified 4 groups with significantly different risk of severe post-operative complications (p < .001).
CONCLUSIONS: Patients undergoing anterior or total pelvic exenteration have a low risk of intra-operative but a remarkable risk of major post-operative complications. No intra-operative death was recorded, and post-operative mortality was low. The COREPEX score predicting the risk of post-operative complications can be used to counsel patients and for future studies.