Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania.
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
J Gynecol Oncol. 2024 Mar;35(2):e12. doi: 10.3802/jgo.2024.35.e12. Epub 2023 Oct 19.
To acknowledge that minimally invasive pelvic exenteration is a feasible alternative to open surgery and potentially identify prediction factors for patient outcome.
The study was designed as a retrospective single team analysis of 12 consecutive cases, set between January 2008 and January 2022.
Six anterior and 6 total pelvic exenterations were performed. A 75% of cases were treated using a robotic approach. In 4 cases, an ileal conduit was used for urinary reconstruction. Mean operative time was 360±30.7 minutes. for anterior pelvic exenterations and 440±40.7 minutes. for total pelvic exenterations and mean blood loss was 350±35 mL. An R0 resection was performed in 9 cases (75%) and peri-operative morbidity was 16.6%, with no deaths recorded. Median disease-free survival was 12 months (10-14) and overall survival (OS) was 20 months (1-127). In terms of OS, 50% of patients were still alive 24 months after surgery. Taking into consideration the follow up period,16.6% of females under 50 or above 70 years old did not reach the cut off and 4 out of 6 patients that failed to reach it were diagnosed with distant metastases or local recurrence (p=0.169).
Our experience is very much consistent with literature in regard to primary site of cancer, post-operative complications, R0 resection and survival rates. On the other hand, minimally invasive approach and urinary reconstruction type were in contrast with cited publications. Minimally invasive pelvic exenteration is indeed a safe and feasible procedure, providing patients selection is appropriately performed.
承认微创盆腔廓清术是一种可行的开放手术替代方法，并可能确定预测患者预后的因素。
该研究设计为 2008 年 1 月至 2022 年 1 月期间连续 12 例病例的回顾性单队分析。
进行了 6 例前盆腔廓清术和 6 例全盆腔廓清术。75%的病例采用机器人辅助方法治疗。在 4 例中，使用回肠导管进行尿路重建。前盆腔廓清术的平均手术时间为 360±30.7 分钟，全盆腔廓清术的平均手术时间为 440±40.7 分钟，平均出血量为 350±35 毫升。9 例（75%）行 R0 切除术，围手术期并发症发生率为 16.6%，无死亡病例。无病生存中位数为 12 个月（10-14），总生存（OS）为 20 个月（1-127）。在 OS 方面，手术后 24 个月时仍有 50%的患者存活。考虑到随访时间，50 岁以下或 70 岁以上的女性中有 16.6%未达到截止值，而未能达到截止值的 6 名患者中有 4 名被诊断为远处转移或局部复发（p=0.169）。
我们的经验与癌症原发部位、术后并发症、R0 切除和生存率的文献非常一致。另一方面，微创方法和尿路重建类型与引用的出版物相反。微创盆腔廓清术确实是一种安全可行的手术，适当的患者选择是可行的。
