Morbidity and Mortality of Total Pelvic Exenteration for Malignancy in the US

Vigneswaran, Hari; Schwarzman, Logan; Madueke, Ikenna; David, Shannon MacLaughlan; Nordenstam, Johan; Moreira, Daniel de Carvalho; Abern, Michael R.

doi:10.1245/s10434-020-09247-2

Cited by 18 publications

(13 citation statements)

References 35 publications

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“…Across four recent studies of pelvic exenteration in PCa and BCa patients (Table 2) [42,43,45 ▪ ], CD grade at least 3 complication rates ranged from 12 to 31%, which is comparable to that observed in large series for curative radical cystectomy [46]. Median symptom-free survival was 16.0 and 27.9 months in a PCa and BCa series, respectively.…”

Section: Pelvic Exenterationsupporting

confidence: 54%

The role of surgery for loco-regional and advanced urological cancers

Chow

Tay

Yuen

et al. 2022

Current Opinion in Urology

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Purpose of reviewThere is a general misconception that surgery is the antithesis of palliation. However, symptom mitigation, the basic tenet of palliative interventions, can be achieved by invasive procedures. Surgical care, thus, plays an important role in palliative oncology, alongside radiation and systemic therapy. There is global movement to improve palliation in oncology, and thus it is timely to evaluate the role of surgical interventions can play in this setting. Recent findingsMany of the surgical interventions done with palliative intent were first established as curative options. Most studies looked at interventions for local control of primary tumour including extirpative surgeries, while some studies studied pain relief for bone metastases. Results show that patients have an acceptable survival outcome and complication rate comparable to those done in the curative setting. However, not all studies report functional outcomes and symptom-relief consistently, highlighting an unmet need. SummaryMore studies are needed to further define the role of surgery in palliative care. Randomized controlled trials studying surgical intervention in the palliative setting will be challenging because of lack of equipoise, inherent bias in patient and disease characteristics in those who undergo surgery. Nonetheless, studies should endeavour to study symptom-free survival and PROMs as meaningful endpoints of interventions performed in a palliative setting rather than solely focus on hard oncological endpoints of survival.

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Section: Pelvic Exenterationsupporting

confidence: 54%

The role of surgery for loco-regional and advanced urological cancers

Chow

Tay

Yuen

et al. 2022

Current Opinion in Urology

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“…In the present study, the mean operation time was 6 hr, comparable to previous series [6,23]; in no case, the operation exceeded 10 hr. Vigneswaran et al [16] found a relationship between an operation period in TPE longer than 6 hr and early wound infection occurrence. The relationship between operation duration and rate of infectious complica-tions is known in the surgical literature.…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, TPE is performed with an open approach, with an extremely long operative time and requiring blood transfusion. Both the need for transfusion and the length of the operation are independent predictors of postoperative infectious complications [15,16]. Infections following TPE occur within 30 days of surgery (early infections) and in the remote postoperative period, defined as late infections, usually with an indication of the observation period for 31-90 days after surgery [17].…”

Section: Introductionmentioning

confidence: 99%

Microbiological characteristics of early and late infectious complications following total pelvic exenteration due to cervical cancer recurrence—the significance of infections in long-term outcomes

Szymankiewicz¹,

Szubert²

2021

European Journal of Gynaecological Oncology

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We analysed microbiological results of early and late infectious complications following total pelvic exenteration (TPE) due to cervical cancer recurrence and evaluated the significance of infections in patient survival. Methods: A retrospective study was conducted on 13 out of 31 patients who had undergone TPE due to cervical cancer, from February 2013 to January 2018. Results: Early and late infections occurred in 7 (53.8%) patients and 6 (46.1%) patients, respectively. Superficial and deep surgical site infections (SSIs) were the only ones that appeared as early infections. Late infections, besides SSIs (4/13; 30.8%), also included urinary infections (2/13; 15.4%). The most frequently isolated microorganisms were Enterococcus spp. (9/28; 32.1%) and Escherichia coli (6/28; 21.4%). There was no resistance to vancomycin, teicoplanin and linezolid among Enterocccus spp. Among gram-negative rods, there was no resistance to meropenem and imipenem. We found three ESBL (extendedspectrum ß-lactamase) producers. Patients diagnosed with early deep SSIs had a shortened median overall survival (5.0 months vs. 11.5 months, P = 0.03). Patient survival was neither related to the occurrence of early superficial infections nor to late infections. Conclusions: Our results suggest that early, especially early deep, SSI may worse the prognosis of patients after TPE. The time of infection management after the operation should be especially intensified within 1 month after TPE.

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“…We believe that further validation during patient selection after CRT is required to estimate A brief review of the feasibility of RA-TPE performed by comparing the short-term outcomes of the other approaches, including conventional TPE, laparoscopic TPE, simultaneous RA surgery of synchronous primary rectal and prostate cancer, is shown in Table 2. The shortterm outcomes of the reported RA-TPE cases seem considerable based on the latest report of a large-scale investigation of TPE [19]. The median operative durations were 480 min (range 200-570 min) for RA-TPE cases and 462 min (range 333-582 min) for conventional TPE.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted total pelvic exenteration for rectal cancer after neoadjuvant chemoradiotherapy: a case report

et al. 2022

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Background There are numerous indications for minimally invasive surgery. However, the laparoscopic approach for extended pelvic surgery is currently provided by only a few institutions specializing in cancer treatment, primarily because of technical difficulties that arise in cases involving a narrow pelvis and rigid forceps. We report a case of robot-assisted total pelvic exenteration for rectal cancer involving the prostate. We assessed the feasibility of robot-assisted total pelvic exenteration and compared the short-term outcomes of other conventional and minimally invasive approaches. Case presentation A 67-year-old man was referred to our hospital after positive fecal blood test results. The initial diagnosis was clinical T4bN2aM0, Stage IIIC rectal cancer involving the prostate. The patient underwent neoadjuvant chemoradiotherapy. Consequently, robot-assisted total pelvic exenteration with an ileal conduit and end colostomy creation were performed. The total operative duration was 9 h and 20 min. The durations of robot console usage by the colorectal and urological teams were 2 h 9 min and 2 h 23 min, respectively. The patient was discharged on postoperative day 21. The pathological diagnosis was T4b (prostate) N0M0, Stage IIC. The resection margin was 2.5 mm. During reassessment at 2 years after resection, no evidence of recurrence was observed. Conclusions Robot-assisted total pelvic exenteration was performed for a patient with advanced rectal cancer without serious complications. Robot-assisted total pelvic exenteration may provide the advantages of minimally invasive surgery, particularly in the enclosed space of the pelvis.

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Morbidity and Mortality of Total Pelvic Exenteration for Malignancy in the US

Cited by 18 publications

References 35 publications

The role of surgery for loco-regional and advanced urological cancers

The role of surgery for loco-regional and advanced urological cancers

Microbiological characteristics of early and late infectious complications following total pelvic exenteration due to cervical cancer recurrence—the significance of infections in long-term outcomes

Robot-assisted total pelvic exenteration for rectal cancer after neoadjuvant chemoradiotherapy: a case report

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