Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
Gynecol Oncol. 2019 May;153(2):368-375. doi: 10.1016/j.ygyno.2019.02.002. Epub 2019 Feb 19.
To examine changes in performance and outcomes of pelvic exenteration for gynecologic malignancies.
This is a population-based retrospective study examining the Nationwide Inpatient Sample between 2001 and 2015. Women with cervical, uterine, vaginal, and vulvar malignancies who underwent pelvic exenteration were examined. Comorbidity, perioperative complications, total charges, length of stay, and mortality were assessed.
There were 2647 cases included. Cervical cancer was the most common malignancy (45.1%), followed by vaginal cancer (27.6%). 26.9% of women had a Charlson Comorbidity Index ≥3, which significantly increased from 23.3% in 2001-2005 to 33.3% in 2011-2015 (42.9% relative increase, P < 0.001). Obese women undergoing exenteration increased significantly from 4.5% in 2001-2005 to 19.4% in 2011-2015 (3.3-fold relative increase, P < 0.001). The perioperative complication rate was 68.1%, including 38.7% with multiple complications. The mortality rate was 1.9%. The number of women with multiple perioperative complications increased from 29.4% in 2001-2005 to 52.8% in 2011-2015 (78.6% relative increase, P < 0.001). More recent year of surgery, obesity, higher comorbidity, higher household income, surgery at large bedsize hospital, urinary diversion, vaginal reconstruction, and vulvar cancer were associated with an increased risk of multiple complications on multivariable analysis (all, P < 0.05). Median length of stay was 14 (IQR 9-21) days, and the number of women hospitalized ≥28 days significantly increased from 12.6% in 2001-2005 to 19.1% in 2011-2015 (51.6% relative increase, P < 0.001). The median corrected total charges increased from $121,854 to $185,100 between 2001 and 2015 (net difference +$63,246, 51.9% relative increase, P < 0.001).
Women undergoing pelvic exenteration for gynecologic malignancies became more obese and comorbid during the study period. Pelvic exenteration for women with gynecologic malignancies is associated with high morbidity and mortality as well as substantial treatment-related costs.
探讨妇科恶性肿瘤盆腔廓清术的疗效和结局变化。
本研究为基于人群的回顾性研究，分析了 2001 年至 2015 年间全美住院患者样本。纳入接受盆腔廓清术治疗的宫颈癌、子宫癌、阴道癌和外阴癌患者。评估了合并症、围手术期并发症、总费用、住院时间和死亡率。
共纳入 2647 例患者。最常见的恶性肿瘤是宫颈癌（45.1%），其次是阴道癌（27.6%）。26.9%的患者Charlson 合并症指数≥3，这一比例从 2001-2005 年的 23.3%显著增加到 2011-2015 年的 33.3%（相对增加 42.9%，P<0.001）。接受廓清术的肥胖患者比例也显著增加，从 2001-2005 年的 4.5%增加到 2011-2015 年的 19.4%（相对增加 3.3 倍，P<0.001）。围手术期并发症发生率为 68.1%，其中 38.7%的患者存在多种并发症。死亡率为 1.9%。2001-2005 年，存在多种围手术期并发症的患者比例为 29.4%，2011-2015 年增加至 52.8%（相对增加 78.6%，P<0.001）。最近的手术年份、肥胖、更高的合并症、更高的家庭收入、在大床位医院进行手术、尿流改道、阴道重建和外阴癌，与多变量分析中的多种并发症风险增加相关（均 P<0.05）。中位住院时间为 14（IQR 9-21）天，≥28 天住院的患者比例从 2001-2005 年的 12.6%显著增加到 2011-2015 年的 19.1%（相对增加 51.6%，P<0.001）。2001 年至 2015 年间，校正后的总费用中位数从 121854 美元增加到 185100 美元（净差值+63246 美元，相对增加 51.9%，P<0.001）。
在研究期间，接受妇科恶性肿瘤盆腔廓清术的女性变得更加肥胖且合并症更多。接受妇科恶性肿瘤盆腔廓清术的患者发病率和死亡率较高，且治疗相关费用也很高。
