Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
Gynecologic Surgery, Mayo Clinic, Rochester, MN.
Int J Gynecol Cancer. 2018 Jun;28(5):975-982. doi: 10.1097/IGC.0000000000001251.
Pelvic exenteration for recurrent gynecological malignancies is characterized by a high rate of severe complications. Factors predictive of morbidity, readmission, and cost were analyzed.
Data of consecutive patients undergoing pelvic exenteration between January 2007 and December 2016 were prospectively evaluated.
Fifty-eight patients were included in the analysis. Anterior, posterior, and total exenterations were executed in 39 (67%), 9 (16%), and 10 (17%) patients, respectively. Ten (15.5%) severe complications occurred: 8 (20.5%), 0 (0%), and 1 (10%) after anterior, posterior, and total exenterations, respectively. Radiotherapy dosage, time between radiotherapy and surgery, and previous administration of chemotherapy did not influence 90-day complications and readmission. At multivariable analysis, albumin levels less than 3.5 g/dL (odds ratio, 16.2 [95% confidence interval, 2.85-92.8]; P = 0.002) and history of deep vein thrombosis (odds ratio, 9.6 [95% confidence interval, 0.93-98.2]; P = 0.057) were associated with 90-day morbidity. Low albumin levels independently correlated with readmission (P = 0.011). The occurrence of 90-day postoperative complications and readmission increased costs of a median of +12,500 and +6000 euros, respectively (P < 0.05).
Preoperative patient selection is a key point for the reduction of postoperative complications after pelvic exenteration. Further prospective studies are warranted to improve patient selection.
复发性妇科恶性肿瘤的盆腔廓清术以严重并发症发生率高为特征。分析了发病率、再入院和成本的预测因素。
前瞻性评估了 2007 年 1 月至 2016 年 12 月连续接受盆腔廓清术的患者的数据。
58 例患者纳入分析。39 例（67%）、9 例（16%）和 10 例（17%）分别行前盆腔廓清术、后盆腔廓清术和全盆腔廓清术。10 例（15.5%）发生严重并发症：前盆腔廓清术、后盆腔廓清术和全盆腔廓清术分别为 8 例（20.5%）、0 例（0%）和 1 例（10%）。放疗剂量、放疗与手术时间间隔以及化疗的前期应用均不影响 90 天并发症和再入院。多变量分析显示，白蛋白水平<3.5 g/dL（比值比，16.2[95%置信区间，2.85-92.8]；P=0.002）和深静脉血栓形成史（比值比，9.6[95%置信区间，0.93-98.2]；P=0.057）与 90 天发病率相关。低白蛋白水平与再入院独立相关（P=0.011）。90 天术后并发症和再入院的发生使中位数增加了 12500 欧元和 6000 欧元的成本（P<0.05）。
盆腔廓清术前患者选择是降低术后并发症的关键。需要进一步的前瞻性研究来改善患者选择。
