West Charles T, Tiwari Abhinav, Salem Yousif, Woyton Michal, Alford Natasha, Roy Shatabdi, Russell Samantha, Ribeiro Ines S, Smith Julian, Yano Hideaki, Cooper Keith, West Malcolm A, Mirnezami Alex H
Southampton Complex Cancer and Exenteration Team, University Hospital Southampton, Southampton SO16 6YD, UK.
Academic Surgery, Cancer Sciences, University of Southampton, Tremona Road, Southampton SO16 6YD, UK.
Cancers (Basel). 2025 Jan 1;17(1):111. doi: 10.3390/cancers17010111.
Conventional pelvic exenteration (PE) comprises the removal of all or most central pelvic organs and is established in clinical practise. Previously, tumours involving bone or lateral sidewall structures were deemed inoperable due to associated morbidity, mortality, and poor oncological outcomes. Recently however high-complexity PE is increasingly described and is defined as encompassing conventional PE with the additional resection of bone or pelvic sidewall structures. This observational cohort study aimed to assess surgical outcomes, health-related quality of life (HrQoL), decision regret, and costs of high-complexity PE for more advanced tumours not treatable with conventional PE. High-complexity PE data were retrieved from a prospectively maintained quaternary database. The primary outcome was overall survival. Secondary outcomes were perioperative mortality, disease control, major morbidity, HrQoL, and health resource use. For cost-utility analysis, a no-PE group was extrapolated from the literature. In total, 319 cases were included, with 64 conventional and 255 high-complexity PE, and the overall survival was equivalent, with medians of 10.5 and 9.8 years ( = 0.52), respectively. Local control ( = 0.30); 90-day mortality (0.0% vs. 1.2%, = 1.00); R0-resection rate (87% vs. 83%, = 0.08); 12-month HrQoL ( = 0.51); and decision regret ( = 0.90) were comparable. High-complexity PE significantly increased overall major morbidity (16% vs. 31%, = 0.02); and perioperative costs (GBP 37,271 vs. GBP 45,733, < 0.001). When modelled against no surgery, both groups appeared cost-effective with incremental cost-effectiveness ratios of GBP 2446 and GBP 5061. High-complexity PE is safe and feasible, offering comparable survival outcomes and HrQoL to conventional PE, but with greater morbidity and resource use. Despite this, it appears cost-effective when compared to no surgery and palliation.
传统盆腔脏器切除术（PE）包括切除全部或大部分盆腔中央器官，且已在临床实践中确立。以前，累及骨骼或侧方结构的肿瘤因相关的发病率、死亡率和较差的肿瘤学结局而被视为无法手术切除。然而，近来越来越多地描述了高复杂性PE，其定义为在传统PE的基础上额外切除骨骼或盆腔侧方结构。这项观察性队列研究旨在评估高复杂性PE治疗传统PE无法治疗的更晚期肿瘤的手术结局、健康相关生活质量（HrQoL）、决策遗憾以及成本。高复杂性PE数据从前瞻性维护的四级数据库中获取。主要结局是总生存期。次要结局是围手术期死亡率、疾病控制、主要并发症、HrQoL以及卫生资源利用。为了进行成本效益分析，从文献中推断出一个未行PE的组。总共纳入319例病例，其中64例行传统PE，255例行高复杂性PE，总生存期相当，中位数分别为10.5年和9.8年（P = 0.52）。局部控制（P = 0.30）；90天死亡率（0.0%对1.2%，P = 1.00）；R0切除率（87%对83%，P = 0.08）；12个月的HrQoL（P = 0.51）；以及决策遗憾（P = 0.90）均具有可比性。高复杂性PE显著增加了总体主要并发症（16%对31%，P = 0.02）；以及围手术期成本（37,271英镑对45,733英镑，P < 0.001）。与未手术相比，两组在建模时均具有成本效益，增量成本效益比分别为2446英镑和5061英镑。高复杂性PE是安全可行的，与传统PE相比具有相当可比生存结局和HrQoL，但并发症更多且资源利用更多。尽管如此，与未手术和姑息治疗相比，它似乎具有成本效益。
