Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Woman and Child Health, Fondazione Policlinico Universitairio A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
Gynecol Oncol. 2019 Jan;152(1):151-156. doi: 10.1016/j.ygyno.2018.10.036. Epub 2018 Nov 8.
Pelvic exenteration (PE) is an extensive surgery associated with high rates of postoperative morbidity and mortality. The absence of well-defined preoperative selection criteria to identify patients eligible for PE prompted the assessment of pre-operative predictors of 30-day major surgical complications.
Demographics and surgical characteristics of patients undergoing PE for gynecologic cancer in a single institution between 01/2004-12/2016 were reviewed. Postoperative complications within 30 days following surgery were graded using the Accordion grading system. Logistic regression was used to analyze potential risk factors for severe postoperative complications.
A total of 138 patients were included in the cohort. Forty-five patients underwent total PE, 52 anterior PE, and 41 posterior PE. Among the 137 patients with follow-up, a severe postoperative complication was experienced by 37 patients (27.0%) and 3 patients (2.2%) experienced death within 90 days. The most frequent grade 3 complications were complications of urinary reconstruction (n = 15), wound dehiscence (n = 9), and abdominal abscess requiring intervention with drain or return to the operating room (n = 6). On multivariable analysis, independent predictors of severe postoperative complications were anterior or total PE (adjusted odds ratio (aOR): 11.66, 95% CI 2.56-53.18), pre-operative hemoglobin ≤10 mg/dl (aOR 2.70, 95% CI 1.02-7.14) and presence of 3+ comorbidities (aOR: 2.76, 95% CI 1.07-7.10).
Major complications after exenteration are common. Surgical complexity and patient selection play a considerable role in predicting complications. These data can be used to better risk stratify patients undergoing PE.
盆腔廓清术（PE）是一种广泛的手术，其术后发病率和死亡率均较高。由于缺乏明确的术前选择标准来确定适合行 PE 的患者，因此评估了术前预测 30 天主要手术并发症的指标。
回顾了 2004 年 1 月至 2016 年 12 月在一家机构中因妇科癌症而行 PE 的患者的人口统计学和手术特征。使用 Accordion 分级系统对术后 30 天内的并发症进行分级。使用逻辑回归分析严重术后并发症的潜在危险因素。
共纳入 138 例患者。45 例患者行全盆腔廓清术，52 例行前盆腔廓清术，41 例行后盆腔廓清术。在有随访的 137 例患者中，37 例（27.0%）患者发生严重术后并发症，3 例（2.2%）患者在 90 天内死亡。最常见的 3 级并发症为尿重建并发症（n=15）、伤口裂开（n=9）和需要引流或返回手术室干预的腹部脓肿（n=6）。多变量分析显示，严重术后并发症的独立预测因素为前盆腔廓清术或全盆腔廓清术（校正比值比[aOR]：11.66，95%CI 2.56-53.18）、术前血红蛋白≤10mg/dl（aOR 2.70，95%CI 1.02-7.14）和存在 3+合并症（aOR：2.76，95%CI 1.07-7.10）。
盆腔廓清术后出现重大并发症较为常见。手术复杂性和患者选择在预测并发症方面起着重要作用。这些数据可用于更好地对行 PE 的患者进行风险分层。
