L Tortorella1, J Casarin2, K C Mara3, A L Weaver3, F Multinu4, G E Glaser2, W A Cliby2, G Scambia5, A Mariani2, A Kumar6. 1. Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Woman and Child Health, Fondazione Policlinico Universitairio A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. 2. Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA. 3. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA. 4. Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Gynecology, European Institute of Oncology (IEO), Milan, Italy. 5. Department of Woman and Child Health, Fondazione Policlinico Universitairio A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. 6. Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: Kumar.amanika@mayo.edu.
Abstract
OBJECTIVE: Pelvic exenteration (PE) is an extensive surgery associated with high rates of postoperative morbidity and mortality. The absence of well-defined preoperative selection criteria to identify patients eligible for PE prompted the assessment of pre-operative predictors of 30-day major surgical complications. METHODS: Demographics and surgical characteristics of patients undergoing PE for gynecologic cancer in a single institution between 01/2004-12/2016 were reviewed. Postoperative complications within 30 days following surgery were graded using the Accordion grading system. Logistic regression was used to analyze potential risk factors for severe postoperative complications. RESULTS: A total of 138 patients were included in the cohort. Forty-five patients underwent total PE, 52 anterior PE, and 41 posterior PE. Among the 137 patients with follow-up, a severe postoperative complication was experienced by 37 patients (27.0%) and 3 patients (2.2%) experienced death within 90 days. The most frequent grade 3 complications were complications of urinary reconstruction (n = 15), wound dehiscence (n = 9), and abdominal abscess requiring intervention with drain or return to the operating room (n = 6). On multivariable analysis, independent predictors of severe postoperative complications were anterior or total PE (adjusted odds ratio (aOR): 11.66, 95% CI 2.56-53.18), pre-operative hemoglobin ≤10 mg/dl (aOR 2.70, 95% CI 1.02-7.14) and presence of 3+ comorbidities (aOR: 2.76, 95% CI 1.07-7.10). CONCLUSIONS: Major complications after exenteration are common. Surgical complexity and patient selection play a considerable role in predicting complications. These data can be used to better risk stratify patients undergoing PE.
OBJECTIVE: Pelvic exenteration (PE) is an extensive surgery associated with high rates of postoperative morbidity and mortality. The absence of well-defined preoperative selection criteria to identify patients eligible for PE prompted the assessment of pre-operative predictors of 30-day major surgical complications. METHODS: Demographics and surgical characteristics of patients undergoing PE for gynecologic cancer in a single institution between 01/2004-12/2016 were reviewed. Postoperative complications within 30 days following surgery were graded using the Accordion grading system. Logistic regression was used to analyze potential risk factors for severe postoperative complications. RESULTS: A total of 138 patients were included in the cohort. Forty-five patients underwent total PE, 52 anterior PE, and 41 posterior PE. Among the 137 patients with follow-up, a severe postoperative complication was experienced by 37 patients (27.0%) and 3 patients (2.2%) experienced death within 90 days. The most frequent grade 3 complications were complications of urinary reconstruction (n = 15), wound dehiscence (n = 9), and abdominal abscess requiring intervention with drain or return to the operating room (n = 6). On multivariable analysis, independent predictors of severe postoperative complications were anterior or total PE (adjusted odds ratio (aOR): 11.66, 95% CI 2.56-53.18), pre-operative hemoglobin ≤10 mg/dl (aOR 2.70, 95% CI 1.02-7.14) and presence of 3+ comorbidities (aOR: 2.76, 95% CI 1.07-7.10). CONCLUSIONS: Major complications after exenteration are common. Surgical complexity and patient selection play a considerable role in predicting complications. These data can be used to better risk stratify patients undergoing PE.
Authors: Koji Matsuo; Shinya Matsuzaki; Rachel S Mandelbaum; Kazuhide Matsushima; Maximilian Klar; Brendan H Grubbs; Lynda D Roman; Jason D Wright Journal: J Surg Oncol Date: 2019-11-19 Impact factor: 3.454
Authors: Oliver Peacock; Peadar S Waters; Joseph C Kong; Satish K Warrier; Chris Wakeman; Tim Eglinton; Declan G Murphy; Alexander G Heriot; Frank A Frizelle; Jacob J McCormick Journal: Tech Coloproctol Date: 2020-01-06 Impact factor: 3.781
Authors: Carlos Martínez-Gómez; Martina Aida Angeles; Alejandra Martinez; Bernard Malavaud; Gwenael Ferron Journal: Int J Gynecol Cancer Date: 2020-11-23 Impact factor: 3.437