Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics, Gynaecology, and Perinatology, Obafemi Awolowo University, Ife, Nigeria.
Gynecol Oncol. 2022 Nov;167(2):277-282. doi: 10.1016/j.ygyno.2022.08.017. Epub 2022 Sep 3.
To evaluate postoperative and oncologic outcomes associated with pelvic exenteration for non-ovarian gynecologic malignancies.
This was a retrospective review of patients who underwent pelvic exenteration for non-ovarian gynecologic malignancies at our institution from 1/1/2010-12/31/2019. Palliative exenteration cases were excluded from survival analysis. Postoperative complications were early (≤30 days) or late (31-180 days). Complications were graded using a validated institutional scale. Major complications were considered grade ≥ 3. Categorical variables were compared using the chi-square test, and the Kaplan-Meier method was used for survival analysis.
Of 100 patients identified, 89 underwent pelvic exenteration for recurrent disease, 5 for palliation, 5 for primary disease, and 1 for persistent disease. Thirty percent had cervical, 27% vulvar, 24% uterine, and 19% vaginal cancer. Sixty-two percent underwent total, 30% anterior, and 8% posterior exenteration. No deaths occurred intraoperatively or within 30 days of surgery. Six patients died after 30 days. Ninety-seven experienced a perioperative complication-49 early, 1 late, and 47 both. Fifty experienced a major complication-22 (44%) early, 19 (38%) late, and 9 (18%) both. No variables were statistically associated with complication development. The 3-year progression-free survival rate was 61.0%; the 3-year overall survival rate was 61.6%. Of 58 surviving patients, 16 (28%) and 4 (7%) were alive after 5 and 10 years, respectively.
The overall complication rate for pelvic exenteration remains high. No variables demonstrated association with complication development as the rate was nearly 100%. The low rate of perioperative mortality is likely due to improved perioperative care.
评估盆腔廓清术治疗非卵巢妇科恶性肿瘤的术后和肿瘤学结果。
这是对本机构 2010 年 1 月 1 日至 2019 年 12 月 31 日期间接受盆腔廓清术治疗非卵巢妇科恶性肿瘤的患者进行的回顾性研究。排除姑息性廓清术病例进行生存分析。术后并发症分为早期（≤30 天）或晚期（31-180 天）。使用经过验证的机构量表对并发症进行分级。严重并发症被认为是等级≥3。使用卡方检验比较分类变量，Kaplan-Meier 法用于生存分析。
在确定的 100 例患者中，89 例因复发性疾病、5 例因姑息性治疗、5 例因原发性疾病和 1 例因持续性疾病接受了盆腔廓清术。30%的患者患有宫颈癌、27%的患者患有外阴癌、24%的患者患有子宫癌和 19%的患者患有阴道癌。62%的患者行全盆腔廓清术、30%的患者行前盆腔廓清术和 8%的患者行后盆腔廓清术。术中或术后 30 天内无死亡病例。30 天后有 6 例患者死亡。97 例患者发生围手术期并发症-49 例为早期并发症、1 例为晚期并发症和 47 例为两者兼有。50 例患者发生严重并发症-22 例（44%）为早期并发症、19 例（38%）为晚期并发症和 9 例（18%）为两者兼有。没有变量与并发症的发生有统计学关联。3 年无进展生存率为 61.0%；3 年总生存率为 61.6%。在 58 例存活患者中，分别有 16 例（28%）和 4 例（7%）在 5 年和 10 年后存活。
盆腔廓清术的总体并发症发生率仍然很高。由于并发症发生率几乎达到 100%，因此没有变量与并发症的发生有关。围手术期死亡率低可能是由于围手术期护理的改善。
