Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Gynecol Oncol. 2024 Oct;189:80-87. doi: 10.1016/j.ygyno.2024.07.674. Epub 2024 Jul 23.
To compare perioperative outcomes in patients undergoing pelvic exenteration for gynecologic malignancies before and after implementation of Enhanced Recovery After Surgery (ERAS) protocols.
We performed an institutional retrospective cohort study of patients undergoing pelvic exenteration for gynecologic malignancies before (1/1/2006-12/30/2014) and after (1/1/2015-6/30/2023) ERAS implementation. We described ERAS compliance rates. We compared outcomes up to 60 days post-exenteration. Complication grades were defined by the Clavien-Dindo system.
Overall, 105 women underwent pelvic exenteration; 74 (70.4%) in the pre-ERAS and 31 (29.5%) in the ERAS cohorts. There were no differences between cohorts in age, body mass index, race, primary disease site, type of exenteration, urinary diversion, or vaginal reconstruction. All patients had complications, with at least one grade II+ complication in 94.6% of pre-ERAS and 90.3% of ERAS patients. The ERAS cohort had more grade I-II gastrointestinal (61.3% vs 21.6%, p < 0.001) and hematologic (61.3% vs 36.5%, p = 0.030) and grade III-IV renal (29.0% vs 12.2%, p = 0.048) and wound (45.2% vs 18.9%, p = 0.008) complications compared to the pre-ERAS cohort. ERAS patients had a higher rate of ileus (38.7% vs 10.8%, p = 0.002), urinary leak (22.6% vs 5.4%, p = 0.014), pelvic abscess (35.5% vs 10.8%, p = 0.005), postoperative bleeding requiring intervention (61.3% vs 28.4%, p = 0.002), and readmission (71.4% vs 46.5%, p = 0.025). Median ERAS compliance was 60%.
Pelvic exenteration remains a morbid procedure, and complications were more common in ERAS compared to pre-ERAS cohorts. ERAS protocols should be optimized and tailored to the complexity of pelvic exenteration compared to standard gynecologic oncology ERAS pathways.
比较实施加速康复外科（ERAS）方案前后妇科恶性肿瘤患者行盆腔廓清术的围手术期结局。
我们对在 ERAS 实施前（2006 年 1 月 1 日至 2014 年 12 月 30 日）和实施后（2015 年 1 月 1 日至 2023 年 6 月 30 日）接受妇科恶性肿瘤盆腔廓清术的患者进行了机构回顾性队列研究。我们描述了 ERAS 依从率。我们比较了术后 60 天内的结局。并发症分级采用 Clavien-Dindo 系统。
共有 105 名女性接受了盆腔廓清术；74 名（70.4%）在 ERAS 实施前，31 名（29.5%）在 ERAS 实施后。两组在年龄、体重指数、种族、原发疾病部位、廓清术类型、尿流改道或阴道重建方面无差异。所有患者均有并发症，在 ERAS 实施前组中，94.6%的患者至少有 1 级 II+并发症，而 ERAS 实施后组中，90.3%的患者至少有 1 级 II+并发症。ERAS 组胃肠道（61.3% vs 21.6%，p<0.001）和血液学（61.3% vs 36.5%，p=0.030）并发症 1-2 级更多，而肾功能（29.0% vs 12.2%，p=0.048）和伤口（45.2% vs 18.9%，p=0.008）并发症 3-4 级更多。与 ERAS 实施前组相比，ERAS 组肠梗阻（38.7% vs 10.8%，p=0.002）、尿漏（22.6% vs 5.4%，p=0.014）、盆腔脓肿（35.5% vs 10.8%，p=0.005）、需要干预的术后出血（61.3% vs 28.4%，p=0.002）和再入院（71.4% vs 46.5%，p=0.025）的发生率更高。ERAS 依从中位数为 60%。
盆腔廓清术仍然是一种高风险的手术，与 ERAS 实施前组相比，ERAS 组的并发症更为常见。与标准妇科肿瘤 ERAS 路径相比，应优化和调整 ERAS 方案以适应盆腔廓清术的复杂性。
