Annals of surgical oncology · 2025
Pelvic Exenteration with En Bloc Excision of the Common or External Iliac Veins: To Reconstruct or Not?
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Garrett Celine, Brown Kilian, Lee Peter J, Shiraev Timothy, Dubenec Steven, Robinson David, Solomon Michael
Аннотация
BACKGROUND: En bloc resection of major pelvic sidewall neurovascular structures during pelvic exenteration is now deemed safe and oncologically feasible. This study aimed to evaluate the surgical, oncological, and quality-of-life (QoL) outcomes of patients who underwent en bloc common iliac or external iliac vein (CIV/EIV) resection during pelvic exenteration with and without venous reconstruction.
METHODS: This was a retrospective cohort study of patients who underwent en bloc CIV/EIV resection during pelvic exenteration at the Royal Prince Alfred Hospital, Sydney (January 1994-July 2024). The Functional Assessment of Cancer Therapy-Colorectal (FACT-C) questionnaire was used to evaluate QoL.
RESULTS: Of 76 patients included in this study, 41 underwent venous reconstruction and 35 did not (recon vs. non-recon groups). There were no statistically significant differences in surgical (including vascular-specific complications), oncological (R0), and QoL outcomes between groups. The non-recon group had increased major complications (42.9% vs. 36.6%) and length of hospital stay (28 vs. 22 days) but reduced estimated blood loss (3000 vs. 4500 mL). The non-recon group had superior median total FACT-C scores at 6- (102 vs. 100) and 12-month intervals (107 vs. 99.6).
CONCLUSION: Selected patients undergoing en bloc CIV/EIV excision without reconstruction may experience similar surgical, oncological, and QoL outcomes as those with reconstruction. When the CIV/EIV is resected, ligation without reconstruction can be performed safely in selected patients where there is evidence of chronic venous outflow obstruction and collateralization.
METHODS: This was a retrospective cohort study of patients who underwent en bloc CIV/EIV resection during pelvic exenteration at the Royal Prince Alfred Hospital, Sydney (January 1994-July 2024). The Functional Assessment of Cancer Therapy-Colorectal (FACT-C) questionnaire was used to evaluate QoL.
RESULTS: Of 76 patients included in this study, 41 underwent venous reconstruction and 35 did not (recon vs. non-recon groups). There were no statistically significant differences in surgical (including vascular-specific complications), oncological (R0), and QoL outcomes between groups. The non-recon group had increased major complications (42.9% vs. 36.6%) and length of hospital stay (28 vs. 22 days) but reduced estimated blood loss (3000 vs. 4500 mL). The non-recon group had superior median total FACT-C scores at 6- (102 vs. 100) and 12-month intervals (107 vs. 99.6).
CONCLUSION: Selected patients undergoing en bloc CIV/EIV excision without reconstruction may experience similar surgical, oncological, and QoL outcomes as those with reconstruction. When the CIV/EIV is resected, ligation without reconstruction can be performed safely in selected patients where there is evidence of chronic venous outflow obstruction and collateralization.