Extended pelvic resection for gynecological malignancies: A review of out-of-the-box surgery

Daix, Manon; Gómez, Carlos Martínez; Ángeles, Martina Aida; Tock, Stéphanie; Gladieff, Laurence; Gabiache, Erwan; Mery-Lamarche, Eliane; Martínez, Alejandra; Cibula, David; Ferron, Gwénaël

doi:10.1016/j.ygyno.2022.03.002

Cited by 6 publications

(3 citation statements)

References 49 publications

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“…In recent years, the limits of resectability have expended continuously offering curative treatment options for once palliative patients. Tumor infiltration beyond the endopelvic cavity, once a limiting factor for curative surgery, has been tested with complete cytoreduction rates (up to 75%) and acceptable morbidity rates (of 28%) coining the term 'out-of-the-box surgery' (Scheme 1) [29][30][31][32]. The reported overall survival for patients with gynecologic malignancies that received complete cytoreduction during 'out-of-the-box surgery' was 32 to 60 months [32,33].…”

Section: Discussionmentioning

confidence: 99%

Pelvic Exenteration for Recurrent Endometrial Cancer: A 15-Year Monocentric Retrospective Study

Fix,

Classen-von Spee,

Baransi

et al. 2023

Cancers

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Treatment options for recurrent endometrial adenocarcinoma are limited. In those cases, secondary surgical procedures such as pelvic exenteration form the only possible curative approach. The aim of this study was analyzing the outcomes of patients who underwent pelvic exenteration during the treatment of recurrent endometrial cancer intending to identify prognostic factors. More than 300 pelvic exenterations were performed. Fifteen patients were selected that received pelvic exenteration for recurrent endometrial adenocarcinoma. Data regarding patient characteristics, indication for surgery, complete cytoreduction, tumor grading and p53- and L1CAM-expression were collected and statistically evaluated. Univariate Cox regression was performed to identify predictive factors for long-term survival. The mean survival after pelvic exenteration for the whole patient population was 22.7 months, with the longest survival reaching up to 69 months. Overall survival was significantly longer for patients with a curative treatment intention (p = 0.015) and for patients with a well or moderately differentiated adenocarcinoma (p = 0.014). Complete cytoreduction seemed favorable with a mean survival of 32 months in contrast to 10 months when complete cytoreduction was not achieved. Pelvic exenteration is a possible treatment option for a selected group of patients resulting in a mean survival of nearly two years, offering a substantial prognostic improvement.

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Section: Discussionmentioning

confidence: 99%

Pelvic Exenteration for Recurrent Endometrial Cancer: A 15-Year Monocentric Retrospective Study

Fix,

Classen-von Spee,

Baransi

et al. 2023

Cancers

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“…A review on this topic was published by Daix and colleagues in 2022, clarifying the concept and potential indications for "out-of-the-box surgery" [40]. Several case series with such extended resections are available in the literature and the results vary as follows: R0 resection rate (75-99%); disease-free survival (34-75%); overall survival (34-75%); and postoperative complications (12-64%) [2,3,38,39].…”

Section: Evaluation Of Tumor Characteristicsmentioning

confidence: 99%

The Role of Pelvic Exenteration in Cervical Cancer: A Review of the Literature

Ubinha,

Pedrão,

Tadini

et al. 2024

Cancers

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Pelvic exenteration represents a radical procedure aimed at achieving complete tumor resection with negative margins. Although it is the only therapeutic option for some cases of advanced tumors, it is associated with several perioperative complications. We believe that careful patient selection is related to better oncologic outcomes and lower complication rates. The objectives of this review are to identify the most current indications for this intervention, suggest criteria for case selection, evaluate recommendations for perioperative care, and review oncologic outcomes and potential associated complications. To this end, an analysis of English language articles in PubMed was performed, searching for topics such as the indication for pelvic exenteration for recurrent gynecologic neoplasms selection of oncologic cases, the impact of tumor size and extent on oncologic outcomes, preoperative and postoperative surgical management, surgical complications, and outcomes of overall survival and recurrence-free survival.

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“…The relevant comorbidities, data from the surgical procedure, and lymph node assessment (i.e., systematic lymphadenectomy, lymph node sampling, or the sentinel lymph node technique (SLN)) were recorded for each patient. The Common Terminology Criteria for Adverse Events (CTCAE) version 5 was used to define intraoperative and postoperative complications [17].…”

Section: Study Design and Populationmentioning

confidence: 99%

Can the Modified Frailty Index (mFI) Predict Intraoperative and Postoperative Complications in Older Women with Endometrial Cancer Undergoing Laparoscopic or Robotic Surgery? A Multicenter Observational Study

Schipa,

Ripa,

Gallotta

et al. 2023

JCM

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Background: This study aims to evaluate the strength of the association between frailty and intraoperative/postoperative complications in patients undergoing minimally invasive surgery (MIS) for endometrial cancer. Methods: In this retrospective observational multicenter cohort study, frailty was defined beforehand by a modified frailty index (mFI) score of ≥3. Multiple logistic regressions were performed to investigate possible preoperative predictors—including frailty, age, and body mass index—of intraoperative and early (within 30 days from surgery) or delayed (beyond 30 days from surgery) postoperative complications. Results: The study involved 577 women, of whom 6.9% (n = 40) were frail with an mFI ≥ 3, while 93.1% (n = 537) were non-frail with an mFI of 0–2. Frail women had a significantly higher rate of intraoperative complications (7.5% vs. 1.7%, p = 0.01), with odds 4.54 times greater (95% CI: 1.18–17.60, p = 0.028). There were no differences in the rate of early postoperative complications (15% vs. 6.9%, p = 0.06) and delayed postoperative complications (2.5% vs. 3.9%, p = 0.65) for frail versus non-frail patients. The odds of early postoperative complications increased by 0.7% (95% CI: 1.00–1.15) for every one-unit increase in age (p = 0.032). Conclusions: Frailty was associated with a significantly higher risk of intraoperative complications in older women undergoing MIS for endometrial cancer. Likewise, increasing age was an independent predictor of early postoperative complications. Our findings support the practice of assessing frailty before surgery to optimize perioperative management in this patient population.

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Extended pelvic resection for gynecological malignancies: A review of out-of-the-box surgery

Cited by 6 publications

References 49 publications

Pelvic Exenteration for Recurrent Endometrial Cancer: A 15-Year Monocentric Retrospective Study

Pelvic Exenteration for Recurrent Endometrial Cancer: A 15-Year Monocentric Retrospective Study

The Role of Pelvic Exenteration in Cervical Cancer: A Review of the Literature

Can the Modified Frailty Index (mFI) Predict Intraoperative and Postoperative Complications in Older Women with Endometrial Cancer Undergoing Laparoscopic or Robotic Surgery? A Multicenter Observational Study

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