Institut Paoli Calmettes, Department of Surgical Oncology, Marseille, France.
Faculty of Medical Sciences, Aix-Marseille University, CNRS, Inserm, CRCM, Marseille, France.
J Gynecol Oncol. 2022 May;33(3):e31. doi: 10.3802/jgo.2022.33.e31. Epub 2022 Feb 4.
Posterior pelvic exenteration (PPE) can be required to achieve complete resection in ovarian cancer (OC) patients with large pelvic disease. This study aimed to analyze morbidity, complete resection rate, and survival of PPE.
Ninety patients who underwent PPE in our Comprehensive Cancer Center between January 2010 and February 2021 were retrospectively identified. To analyze practice evolution, 2 periods were determined: P1 from 2010 to 2017 and P2 from 2018 to 2021.
A 82.2% complete resection rate after PPE was obtained, with rectal anastomosis in 96.7% of patients. Complication rate was at 30% (grade 3 in 9 patients), without significant difference according to periods or quality of resection. In a binary logistic regression adjusted on age and stoma, only age of 51-74 years old was associated with a lower rate of complication (odds ratio=0.223; p=0.026). Median overall and disease-free survivals (OS and DFS) from initial diagnosis were 75.21 and 29.84 months, respectively. A negative impact on OS and DFS was observed in case of incomplete resection, and on DFS in case of final cytoreductive surgery (FCS: after ≥6 chemotherapy cycles). Age ≥75-years had a negative impact on DFS for new OC surgery. For patients with complete resection, OS and DFS were decreased in case of interval cytoreductive surgery and FCS in comparison with primary cytoreductive surgery.
PPE is an effective surgical measure to achieve complete resection for a majority of patients. High rate of colorectal anastomosis was achieved without any mortality, with acceptable morbidity and high protective stoma rate.
在患有大型盆腔疾病的卵巢癌（OC）患者中，为了实现完全切除，可能需要进行后盆腔切除术（PPE）。本研究旨在分析 PPE 的发病率、完全切除率和生存率。
回顾性分析 2010 年 1 月至 2021 年 2 月期间在我院综合癌症中心接受 PPE 的 90 例患者。为了分析实践演变，确定了 2 个时期：P1 期为 2010 年至 2017 年，P2 期为 2018 年至 2021 年。
PPE 后完全切除率为 82.2%，96.7%的患者行直肠吻合术。并发症发生率为 30%（9 例为 3 级），与时期或切除质量无关。在调整年龄和造口的二项逻辑回归中，只有 51-74 岁的年龄与较低的并发症发生率相关（优势比=0.223；p=0.026）。从初始诊断开始的总生存期（OS）和无病生存期（DFS）的中位数分别为 75.21 和 29.84 个月。不完全切除与 OS 和 DFS 呈负相关，最终减瘤手术（FCS：在≥6 个化疗周期后）与 DFS 呈负相关。年龄≥75 岁与新 OC 手术的 DFS 呈负相关。对于完全切除的患者，与原发性减瘤手术相比，间隔减瘤手术和 FCS 会降低 OS 和 DFS。
PPE 是实现大多数患者完全切除的有效手术措施。结直肠吻合术的高成功率，无任何死亡率，可接受的发病率和高保护性造口术率。
