B Smith1, E L Jones2, M Kitano3, A L Gleisner4, N J Lyell5, G Cheng6, M D McCarter4, S Abdel-Misih5, F J Backes7. 1. Division of Gynecologic Oncology, The Ohio State University, James Cancer Hospital, Columbus, OH, United States. 2. Division of Gastroenterology, Tumor, and Endocrine Surgery, University of Colorado, Denver, Denver, CO, United States. 3. Division of Surgical Oncology and Endocrine Surgery, University of Texas Health, San Antonio, San Antonio, TX, United States. 4. Division of Surgical Oncology, University of Colorado, Denver, Denver, CO, United States. 5. Division of Surgical Oncology, The Ohio State University, James Cancer Hospital, Columbus, OH, United States. 6. Division of Gynecologic Oncology, University of Colorado, Denver, Denver, CO, United States. 7. Division of Gynecologic Oncology, The Ohio State University, James Cancer Hospital, Columbus, OH, United States. Electronic address: Floor.backes@osumc.edu.
Abstract
OBJECTIVE: Pelvic exenteration (PE) is often the only curative option for locally advanced or recurrent pelvic malignancies. Despite radical surgery, recurrence risk and morbidity remain high. In this study, we sought to determine tumor size effect on perioperative outcomes and subsequent survival in patients undergoing PE. METHODS: Retrospective chart review was performed for female patients who underwent PE at two comprehensive cancer centers from 2000 to 2015. Demographics, complications and outcomes were recorded. Statistical analyses were performed using chi-square, student's t-test, logistic regression, non-parametric tests, log-rank test, and Cox proportional hazards. RESULTS: Of 151 women who underwent PE, 144 had available pathologic tumor size. Gynecologic oncology, surgical oncology, and urology performed 84, 29, and 31 exenterations, respectively. Tumor dimensions ranged from 0 to 25.5cm. Perioperative complications, 30-day mortality, reoperation, and readmission rates were not associated with tumor size. Obesity and prior radiation increased risk for major perioperative complication while anterior exenterations decreased risk. Larger tumors were more likely to undergo total pelvic exenteration (OR 1.14; 95%CI 1.03-1.27), have positive margins (OR 1.11; 95%CI 1.02-1.22), and recur (65%, 42% and 20% for tumors >4cm, ≤4cm and no residual tumor respectively, p=0.016). Tumor size >4cm and positive margins were associated with worse overall survival amongst gynecologic oncology patients. CONCLUSION: Tumor size was not associated with perioperative morbidity. Larger tumors were associated with positive margins, more extensive resection, and worse survival in gynecologic oncology patients. Larger studies are needed to further understand tumor size impact on PE outcomes within specific tumor types.
OBJECTIVE: Pelvic exenteration (PE) is often the only curative option for locally advanced or recurrent pelvic malignancies. Despite radical surgery, recurrence risk and morbidity remain high. In this study, we sought to determine tumor size effect on perioperative outcomes and subsequent survival in patients undergoing PE. METHODS: Retrospective chart review was performed for female patients who underwent PE at two comprehensive cancer centers from 2000 to 2015. Demographics, complications and outcomes were recorded. Statistical analyses were performed using chi-square, student's t-test, logistic regression, non-parametric tests, log-rank test, and Cox proportional hazards. RESULTS: Of 151 women who underwent PE, 144 had available pathologic tumor size. Gynecologic oncology, surgical oncology, and urology performed 84, 29, and 31 exenterations, respectively. Tumor dimensions ranged from 0 to 25.5cm. Perioperative complications, 30-day mortality, reoperation, and readmission rates were not associated with tumor size. Obesity and prior radiation increased risk for major perioperative complication while anterior exenterations decreased risk. Larger tumors were more likely to undergo total pelvic exenteration (OR 1.14; 95%CI 1.03-1.27), have positive margins (OR 1.11; 95%CI 1.02-1.22), and recur (65%, 42% and 20% for tumors >4cm, ≤4cm and no residual tumor respectively, p=0.016). Tumor size >4cm and positive margins were associated with worse overall survival amongst gynecologic oncology patients. CONCLUSION:Tumor size was not associated with perioperative morbidity. Larger tumors were associated with positive margins, more extensive resection, and worse survival in gynecologic oncology patients. Larger studies are needed to further understand tumor size impact on PE outcomes within specific tumor types.
Authors: Alli M Straubhar; Andrew J Chi; Qin C Zhou; Alexia Iasonos; Olga T Filippova; Mario M Leitao; Ibraheem O Awowole; Nadeem R Abu-Rustum; Vance A Broach; Elizabeth L Jewell; Jaspreet S Sandhu; Yukio Sonoda Journal: Gynecol Oncol Date: 2021-09-10 Impact factor: 5.482