Di Donato Violante, Kontopantelis Evangelos, De Angelis Emanuele, Arseni Roberta Maria, Santangelo Giusi, Cibula David, Angioli Roberto, Plotti Francesco, Muzii Ludovico, Vizzielli Giuseppe, Tozzi Roberto, Chiantera Vito, Caruso Giuseppe, Giannini Andrea, Scambia Giovanni, Abu-Rustum Nadeem R, Benedetti Panici Pierluigi, Bogani Giorgio
University Sapienza of Roma, Department of Obstetrics and Gynecology, Rome, Italy.
University of Manchester, Division of Informatics, Imaging and Data Sciences, Manchester, UK.
Int J Gynecol Cancer. 2025 Jun;35(6):101829. doi: 10.1016/j.ijgc.2025.101829. Epub 2025 Apr 11.
Pelvic exenteration is a radical surgery for advanced or recurrent pelvic tumors, requiring careful patient selection and a multi-disciplinary approach. Despite advancements, it remains high-risk, with limited data on outcomes. The present meta-analysis evaluates survival, mortality, and trends to clarify its role in gynecologic oncology.
A systematic search was conducted in January 2025 to identify studies on pelvic exenteration outcomes for gynecologic malignancies. Studies with at least 10 patients reporting 5-year overall survival or 30-day mortality were included. Data extracted included patient and surgical characteristics, and a scoring system based on study design, sample size, and center volume was used to include high-quality studies (score ≥3). Poisson regression models were used to analyze the associations between predictors and outcomes, with results expressed as incidence rate ratios and a 95% CI.
A total of 46 studies involving 4417 patients met the inclusion criteria. Most patients underwent pelvic exenteration for cervical cancer (N = 3183). Positive pelvic and aortic nodal involvement were key predictors of reduced 5-year overall survival, decreasing by 3.9% and 5.9% per 1% increase in nodal positivity, respectively. Pelvic wall involvement also significantly reduced survival by 15.9%. The 30-day mortality rate was 5.1%, with sepsis (27.2%) being the leading cause of death. Peri-operative mortality decreased significantly over time, with each year of publication associated with a 2.6% decrease in incidence rate. However, pelvic sidewall involvement and total exenteration increased 30-day mortality by 11.5% and 0.7%, respectively.
Pelvic exenteration remains a viable but high-risk option for select patients with advanced gynecologic malignancies. Pre-operative assessment and multi-disciplinary planning are essential for optimizing outcomes.
盆腔脏器清除术是针对晚期或复发性盆腔肿瘤的一种根治性手术，需要仔细选择患者并采用多学科方法。尽管取得了进展，但它仍然是高风险手术，关于其结局的数据有限。本荟萃分析评估生存率、死亡率及相关趋势，以阐明其在妇科肿瘤学中的作用。
于2025年1月进行系统检索，以确定关于妇科恶性肿瘤盆腔脏器清除术结局的研究。纳入至少有10例患者报告5年总生存率或30天死亡率的研究。提取的数据包括患者和手术特征，并使用基于研究设计、样本量和中心规模的评分系统纳入高质量研究（评分≥3）。采用泊松回归模型分析预测因素与结局之间的关联，结果以发病率比和95%置信区间表示。
共有46项研究涉及4417例患者符合纳入标准。大多数患者因宫颈癌接受盆腔脏器清除术（N = 3183）。盆腔和主动脉旁淋巴结阳性是5年总生存率降低的关键预测因素，淋巴结阳性率每增加1%，5年总生存率分别降低3.9%和5.9%。盆腔壁受累也显著降低生存率，降低了15.9%。30天死亡率为5.1%，脓毒症（27.2%）是主要死亡原因。围手术期死亡率随时间显著降低，每年发表的研究其发病率降低2.6%。然而，盆腔侧壁受累和全盆腔脏器清除术分别使30天死亡率增加11.5%和0.7%。
对于部分晚期妇科恶性肿瘤患者，盆腔脏器清除术仍然是一种可行但高风险的选择。术前评估和多学科规划对于优化结局至关重要。
