Lampe Björn, Luengas-Würzinger Verónica, Weitz Jürgen, Roth Stephan, Rawert Friederike, Schuler Esther, Classen-von Spee Sabrina, Fix Nando, Baransi Saher, Dizdar Anca, Mallmann Peter, Schaser Klaus-Dieter, Bogner Andreas
Department of Gynecology & Obstetrics, Florence Nightingale Hospital, Kreuzbergstr. 79, 40489 Düsseldorf, Germany.
Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany.
Cancers (Basel). 2021 Dec 7;13(24):6162. doi: 10.3390/cancers13246162.
The practice of exenterative surgery is sometimes controversial and has garnered a certain scepticism. Surgical studies are difficult to conduct due to insufficient data. The aim of this review is to present the current standing of pelvic exenteration from a surgical, gynaecological and urological point of view.
This review is based upon a literature review (MEDLINE (PubMed), CENTRAL (Cochrane) and EMBASE (Elsevier)) of retrospective studies on exenterative surgery from 1993-2020. Using MeSH (Medical Subject Headings) search terms, 1572 publications were found. These were evaluated and screened with respect to their eligibility using algorithms and well-defined inclusion and exclusion criteria. Therefore, the guidelines for systematic reviews (PRISMA) were used.
A complete tumour resection (R0) often represents the only curative option for advanced pelvic carcinomas and their recurrences. A recent systematic review showed significant symptom relief in 80% of palliative patients after pelvic exenteration. Surgical limitations (distant metastases, involvement of the pelvic wall, etc.) are diminished by adequate surgical expertise and close interdisciplinary cooperation. While the mortality rate is low (2-5%), the still relatively high morbidity rate (32-84%) can be minimized by optimizing the perioperative setting. Following exenterations, roughly 79-82% of patients report satisfying results according to PROs (patient-reported outcomes).
Due to multimodality treatment strategies combined with extended surgical expertise and patients' preferences, pelvic exenteration can be offered nowadays with low mortality and acceptable postoperative quality of life. The possibilities of surgical treatment are often underestimated. A multi-centre database (PelvEx Collaborative) was established to collect data and experiences to optimize the research in this field.
盆腔脏器清除术的实施有时存在争议，并引发了一定程度的怀疑。由于数据不足，外科研究难以开展。本综述的目的是从外科、妇科和泌尿外科的角度阐述盆腔脏器清除术的现状。
本综述基于对1993年至2020年盆腔脏器清除术回顾性研究的文献综述（MEDLINE（PubMed）、CENTRAL（Cochrane）和EMBASE（Elsevier））。使用医学主题词（MeSH）检索词，共找到1572篇出版物。根据算法以及明确的纳入和排除标准对这些文献进行评估和筛选。因此，采用了系统评价的指南（PRISMA）。
完整的肿瘤切除（R0）通常是晚期盆腔癌及其复发的唯一治愈选择。最近一项系统评价显示，盆腔脏器清除术后80%的姑息治疗患者症状得到显著缓解。通过足够的外科专业知识和密切的多学科合作，可减少手术限制（远处转移、盆腔壁受累等）。虽然死亡率较低（2 - 5%），但通过优化围手术期条件，仍相对较高的发病率（32 - 84%）可降至最低。盆腔脏器清除术后，根据患者报告结局（PROs），约79 - 82%的患者报告结果满意。
由于多模式治疗策略、扩展的外科专业知识以及患者的偏好，如今开展盆腔脏器清除术可实现低死亡率和可接受的术后生活质量。手术治疗的可能性常常被低估。已建立一个多中心数据库（PelvEx协作组）来收集数据和经验，以优化该领域的研究。
