Surgical results of pelvic exenteration in the treatment of gynecologic cancer.

Autor: Petruzziello A; Surgical Oncology, Department of Surgery, Erasto Gaertner Hospital, Curitiba, Brazil. petruzziello123@hotmail.com., Kondo W, Hatschback SB, Guerreiro JA, Filho FP, Vendrame C, Luz M, Ribeiro R
Jazyk: angličtina
Zdroj: World journal of surgical oncology [World J Surg Oncol] 2014 Sep 08; Vol. 12, pp. 279. Date of Electronic Publication: 2014 Sep 08.
DOI: 10.1186/1477-7819-12-279
Abstrakt: Background: Our aim in the present study was to evaluate surgical outcomes and complications of pelvic exenteration in the treatment of gynecologic malignancy and to compare surgery-related complications associated with different types of exenteration.
Methods: We performed a retrospective analysis of patients who underwent pelvic exenteration for the treatment of gynecologic cancer between January 2008 and August 2011. Patients were divided into two groups for comparison: total pelvic exenteration (TPE) and nontotal pelvic exenteration (NTE, including anterior pelvic exenteration (APE) posterior pelvic exenteration (PPE)). Outcomes are reported according to the modified Clavien-Dindo Classification of Surgical Complications.
Results: Twenty-eight patients were included in the analysis. Eighteen had cervical cancer (64.3%). The prevalence of stage IIIB cervical cancer was 55%. Primary treatment with radiotherapy was performed in 53.3% of patients. Fifty percent of patients underwent TPE, 25% had APE and 25% underwent PPE. Patients who underwent TPE had worse outcomes, with a mean operative time of 367 minutes, use of blood transfusion in 93% of patients, ICU stay of 4.3 days and total hospital stay of 9.4 days. The overall mortality rate was 14.3%, and the surgical site infection rate was 25%. In the TPE group, 78.6% of patients experienced surgical complications. One-fourth of the total patient sample required reoperation, and the leading cause was urinary fistula (57.1%). Urinary leakage occurred in 22.7% of urinary reconstruction patients. Wet colostomy was the most common form of reconstruction with 10% of leakage.
Conclusions: Postoperative urinary and infectious complications accounted for 75% of all causes of morbidity and mortality after pelvic exenteration. TPE is a more complex and morbid procedure than NTE.
Databáze: MEDLINE
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