Department of Surgical Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
Department of Gynecology Oncology, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Asian Pac J Cancer Prev. 2022 Apr 1;23(4):1137-1145. doi: 10.31557/APJCP.2022.23.4.1137.
Total Pelvic Exenteration (TPE) is a radical operation for malignancies in which all of the organs inside the pelvic cavity, including the female reproductive organs, the lower urinary tract, and a part of the rectosigmoid are removed. In this study, we aimed to conduct a systematic review to assess the overall survival (OS) and disease-free survival (DFS) following TPE.
This systematic review is composed of a comprehensive review of PubMed and Scopus databases with various related keywords to synthesis the overall survival and disease-free survival following TPE. The Synthesis Without Meta-analysis guideline was used to summarize the results.
We included the results of 39 primary studies and the results revealed that one-year OS of gynecological cancer in patients who have undergone TPE ranged from 50.0% to 72.0% and the 5-years OS ranged from 6.0% to 64.6%. The one-year survival rate of colorectal cancer patients was reported to be over 80% in almost all studies. The 3-year survival rate of patients varied from 25% to 75% and the lowest 5-year survival rate was 8% and the highest survival rate was 92%. To synthesis the disease-free survival rate in colorectal cancer, ten studies were included and one-year recurrence rate was 9.1% and the one-year DFS was reported as 61.0%. Three-year recurrence rate study was 20.4% and 3 and 5-year DFS ranged from 22.0% to 78.0%.
The results suggested that DFS in primary advanced cancers is higher than locally recurrence tumors. This review showed that patient overall survival and disease-free survival rates have increased over time, especially at high volume centers that are more experienced and possibly better equipped. Therefore, it can be suggested that the attitude towards PE as a palliative surgery can be turned into curative surgery.
全盆腔脏器切除术（TPE）是一种针对盆腔内所有器官恶性肿瘤的根治性手术，包括女性生殖器官、下尿路和部分直肠乙状结肠。本研究旨在进行系统评价，评估 TPE 后的总生存率（OS）和无病生存率（DFS）。
本系统评价由对 PubMed 和 Scopus 数据库的全面综述组成，使用了各种相关的关键词来综合 TPE 后的总生存率和无病生存率。采用无荟萃分析综合指南来总结结果。
我们纳入了 39 项主要研究的结果，结果显示，接受 TPE 的妇科癌症患者的 1 年 OS 从 50.0%到 72.0%不等，5 年 OS 从 6.0%到 64.6%不等。几乎所有研究都报道了接受 TPE 的结直肠癌患者的 1 年生存率超过 80%。患者的 3 年生存率从 25%到 75%不等，最低 5 年生存率为 8%，最高生存率为 92%。为了综合结直肠癌的无病生存率，纳入了 10 项研究，1 年复发率为 9.1%，1 年 DFS 为 61.0%。3 年复发率研究为 20.4%，3 年和 5 年 DFS 范围为 22.0%至 78.0%。
结果表明，DFS 在原发性晚期癌症中高于局部复发肿瘤。本综述表明，患者的总生存率和无病生存率随着时间的推移有所提高，尤其是在经验更丰富、设备可能更好的大容量中心。因此，可以建议将 TPE 作为姑息性手术的态度转变为根治性手术。
