Garrett Celine, Brown Kilian, Lee Peter J, Shiraev Timothy, Dubenec Steven, Robinson David, Solomon Michael
Department of Colorectal or Vascular Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Ann Surg Oncol. 2025 Sep 16. doi: 10.1245/s10434-025-18308-3.
En bloc resection of major pelvic sidewall neurovascular structures during pelvic exenteration is now deemed safe and oncologically feasible. This study aimed to evaluate the surgical, oncological, and quality-of-life (QoL) outcomes of patients who underwent en bloc common iliac or external iliac vein (CIV/EIV) resection during pelvic exenteration with and without venous reconstruction.
This was a retrospective cohort study of patients who underwent en bloc CIV/EIV resection during pelvic exenteration at the Royal Prince Alfred Hospital, Sydney (January 1994-July 2024). The Functional Assessment of Cancer Therapy-Colorectal (FACT-C) questionnaire was used to evaluate QoL.
Of 76 patients included in this study, 41 underwent venous reconstruction and 35 did not (recon vs. non-recon groups). There were no statistically significant differences in surgical (including vascular-specific complications), oncological (R0), and QoL outcomes between groups. The non-recon group had increased major complications (42.9% vs. 36.6%) and length of hospital stay (28 vs. 22 days) but reduced estimated blood loss (3000 vs. 4500 mL). The non-recon group had superior median total FACT-C scores at 6- (102 vs. 100) and 12-month intervals (107 vs. 99.6).
Selected patients undergoing en bloc CIV/EIV excision without reconstruction may experience similar surgical, oncological, and QoL outcomes as those with reconstruction. When the CIV/EIV is resected, ligation without reconstruction can be performed safely in selected patients where there is evidence of chronic venous outflow obstruction and collateralization.
盆腔脏器清除术中整块切除主要盆腔侧壁神经血管结构目前被认为是安全且在肿瘤学上可行的。本研究旨在评估在盆腔脏器清除术中进行或未进行静脉重建的整块髂总静脉或髂外静脉（CIV/EIV）切除患者的手术、肿瘤学及生活质量（QoL）结局。
这是一项对悉尼皇家阿尔弗雷德王子医院（1994年1月至2024年7月）接受盆腔脏器清除术中整块CIV/EIV切除患者的回顾性队列研究。采用癌症治疗功能评估-结直肠癌（FACT-C）问卷评估生活质量。
本研究纳入的76例患者中，41例进行了静脉重建，35例未进行（重建组与未重建组）。两组在手术（包括血管特异性并发症）、肿瘤学（R0）和生活质量结局方面无统计学显著差异。未重建组的主要并发症发生率增加（42.9%对36.6%），住院时间延长（28天对22天），但估计失血量减少（3000 mL对4500 mL）。未重建组在6个月（102对100）和12个月时的FACT-C总评分中位数更高（107对99.6）。
部分接受整块CIV/EIV切除且未进行重建的患者可能会有与重建患者相似的手术、肿瘤学和生活质量结局。当切除CIV/EIV时，对于有慢性静脉流出道梗阻和侧支循环证据的部分患者，可以安全地进行结扎而不进行重建。
