Morbidity and Mortality of Total Pelvic Exenteration for Malignancy in the US
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ORIGINAL ARTICLE – COLORECTAL CANCER
Morbidity and Mortality of Total Pelvic Exenteration for Malignancy in the US Hari T. Vigneswaran, MD1 , Logan S. Schwarzman, BS1, Ikenna C. Madueke, MD, PhD1, Shannon MacLaughlan David, MD2, Johan Nordenstam, MD, PhD3, Daniel Moreira , MD, MHS1, and Michael R. Abern, MD1 Department of Urology, University of Illinois at Chicago, Chicago, IL; 2Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL; 3Department of Surgery, University of Illinois at Chicago, Chicago, IL
1
ABSTRACT Background. Total pelvic exenterations (TPEs) for malignancies are complex operations often performed by multidisciplinary teams. The differences among primary cancer for TPE and multicentered results are not well described. We aimed to describe TPE outcomes for different malignant origins in a national multicentered sample. Methods. Patients from the National Surgical Quality Improvement Program (NSQIP) database who underwent TPE between 2005 and 2016 for all malignant indications (colorectal, gynecologic, urologic, or other) were included. Chi square and Kruskal–Wallis tests were used to compare patient characteristics by primary malignancy. Multivariate logistic and linear regression models were used to determine factors associated with any 30-day Clavien–Dindo grade 3 or higher complication, length of hospital stay (LOS; days), 30-day wound infection, and 30-day mortality.
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09247-2) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 20 July 2020 Accepted: 27 September 2020 H. T. Vigneswaran, MD e-mail: [email protected]
Results. Overall, 2305 patients underwent TPE. Indications for surgery included 33% (749) colorectal, 15% (335) gynecologic, 9% (196) other, and 45% (1025) urologic malignancies. Median LOS decreased from 10 to 8 days during the study period (p \ 0.001), 36% were males, and 50% required blood transfusion. High-grade complications occurred in 15% of patients and were associated with bowel diversion [odds ratio (OR) 1.6, 95% confidence interval (CI) 1.1–2.4], disseminated cancer (OR 1.8, 95% CI 1.4–2.3), and gynecologic cancers (OR 2.9, 95% CI 1.8–4.7). Mortality was 2% and was associated with disseminated cancer (OR 2.2, 95% CI 1.1–4.3) and male sex (OR 2.4, 95% CI 1.3–4.4). Conclusions. TPE is associated with high rates of complications, however mortality rates remain low. Preoperative and perioperative outcomes differ depending on the origin of the primary malignancy.
H. T. Vigneswaran et al.
Graphic Abstract.
TPE Cancer Origin National Sample (NSQIP) 2005–2016
n=2305
45%
35%
15%
9%
Urologic
Colorectal
Gynecologic
Other
TPE Outcomes
64% Women
36% Men
15% Major Complications
Total pelvic exenteration (TPE) remains a final surgical effort for patients with advanced pelvic malignancies. TPE was first proposed in 1948 by Alexander Brunschwig as a palliative ca
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