Moolenaar L R, van Rangelrooij L E, van Poelgeest M I E, van Beurden M, van Driel W J, van Lonkhuijzen L R C W, Mom C H, Zaal A
Department of Gynecologic Oncology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Gynecologic Oncology, Amsterdam University Medical Center, Centre for Gynecologic Oncology Amsterdam, Amsterdam, the Netherlands.
Gynecol Oncol. 2023 Apr;171:114-120. doi: 10.1016/j.ygyno.2023.02.010. Epub 2023 Mar 2.
The aim of this study was to analyze morbidity and survival after pelvic exenteration for gynecologic malignancies and evaluate prognostic factors influencing postoperative outcome.
We retrospectively reviewed all patients who underwent a pelvic exenteration at the departments of gynecologic oncology of three tertiary care centers in the Netherlands, the Leiden University Medical Centre, the Amsterdam University Medical Centre, and the Netherlands Cancer Institute, during a 20-year period. We determined postoperative morbidity, 2- and 5-year overall survival (OS) and 2- and 5-year progression free survival (PFS), and investigated parameters influencing these outcomes.
A total of 90 patients were included. The most common primary tumor was cervical cancer (n = 39, 43.3%). We observed at least one complication in 83 patients (92%). Major complications were seen in 55 patients (61%). Irradiated patients had a higher risk of developing a major complication. Sixty-two (68.9%) required ≥1 readmission. Re-operation was required in 40 patients (44.4%). Median OS was 25 months and median PFS was 14 months. The 2-year OS rate was 51.1% and the 2-year PFS rate was 41.5%. Tumor size, resection margins and pelvic sidewall involvement had a negative impact on OS (HR = 2.159, HR = 2.376, and HR = 1.200, respectively). Positive resection margins and pelvic sidewall involvement resulted in decreased PFS (HR = 2.567 and HR = 3.969, respectively).
Postoperative complications after pelvic exenteration for gynecologic malignancies are common, especially in irradiated patients. In this study, a 2-year OS rate of 51.1% was observed. Positive resections margins, tumor size, and pelvic sidewall involvement were related to poor survival outcomes. Adequate selection of patients who will benefit from pelvic exenteration is important.
本研究旨在分析妇科恶性肿瘤盆腔廓清术后的发病率和生存率，并评估影响术后结局的预后因素。
我们回顾性分析了荷兰三家三级医疗中心（莱顿大学医学中心、阿姆斯特丹大学医学中心和荷兰癌症研究所）妇科肿瘤科室在20年期间接受盆腔廓清术的所有患者。我们确定了术后发病率、2年和5年总生存率（OS）以及2年和5年无进展生存率（PFS），并研究了影响这些结局的参数。
共纳入90例患者。最常见的原发肿瘤是宫颈癌（n = 39，43.3%）。我们观察到83例患者（92%）至少出现一种并发症。55例患者（61%）出现主要并发症。接受过放疗的患者发生主要并发症的风险更高。62例（68.9%）患者需要≥1次再次入院。40例患者（44.4%）需要再次手术。中位总生存期为25个月，中位无进展生存期为14个月。2年总生存率为51.1%，2年无进展生存率为41.5%。肿瘤大小、切缘和盆腔侧壁受累对总生存期有负面影响（风险比分别为2.159、2.376和1.200）。切缘阳性和盆腔侧壁受累导致无进展生存期降低（风险比分别为2.567和3.969）。
妇科恶性肿瘤盆腔廓清术后的并发症很常见，尤其是在接受过放疗的患者中。在本研究中，观察到2年总生存率为51.1%。切缘阳性、肿瘤大小和盆腔侧壁受累与不良生存结局相关。充分选择能从盆腔廓清术中获益的患者很重要。
