Synapse - A modern-day experience with Brunschwig's operation: Outcomes associated with pelvic exenteration

A modern-day experience with Brunschwig's operation: Outcomes associated with pelvic exenteration Journal Article

Authors:	Rios-Doria, E.; Filippova, O. T.; Straubhar, A. M.; Chi, A.; Awowole, I.; Sandhu, J.; Broach, V.; Mueller, J. J.; Gardner, G. J.; Jewell, E. L.; Zivanovic, O.; Leitao, M. M. Jr; Long Roche, K.; Abu-Rustum, N. R.; Sonoda, Y.
Article Title:	A modern-day experience with Brunschwig's operation: Outcomes associated with pelvic exenteration
Abstract:	Objective: To evaluate postoperative and oncologic outcomes associated with pelvic exenteration for non-ovarian gynecologic malignancies. Methods: This was a retrospective review of patients who underwent pelvic exenteration for non-ovarian gynecologic malignancies at our institution from 1/1/2010–12/31/2019. Palliative exenteration cases were excluded from survival analysis. Postoperative complications were early (≤30 days) or late (31–180 days). Complications were graded using a validated institutional scale. Major complications were considered grade ≥ 3. Categorical variables were compared using the chi-square test, and the Kaplan-Meier method was used for survival analysis. Results: Of 100 patients identified, 89 underwent pelvic exenteration for recurrent disease, 5 for palliation, 5 for primary disease, and 1 for persistent disease. Thirty percent had cervical, 27% vulvar, 24% uterine, and 19% vaginal cancer. Sixty-two percent underwent total, 30% anterior, and 8% posterior exenteration. No deaths occurred intraoperatively or within 30 days of surgery. Six patients died after 30 days. Ninety-seven experienced a perioperative complication—49 early, 1 late, and 47 both. Fifty experienced a major complication—22 (44%) early, 19 (38%) late, and 9 (18%) both. No variables were statistically associated with complication development. The 3-year progression-free survival rate was 61.0%; the 3-year overall survival rate was 61.6%. Of 58 surviving patients, 16 (28%) and 4 (7%) were alive after 5 and 10 years, respectively. Conclusion: The overall complication rate for pelvic exenteration remains high. No variables demonstrated association with complication development as the rate was nearly 100%. The low rate of perioperative mortality is likely due to improved perioperative care. © 2022 Elsevier Inc.
Keywords:	adult; cancer survival; controlled study; aged; survival analysis; cancer surgery; major clinical study; overall survival; histopathology; mortality; cancer recurrence; squamous cell carcinoma; cancer patient; outcome assessment; follow up; endometrioid carcinoma; pancreaticoduodenectomy; adenocarcinoma; progression free survival; tumor volume; bleeding; neuropathy; vagina; palliative therapy; retrospective study; cancer survivor; length of stay; body mass; disease severity; conservative treatment; operation duration; pelvis exenteration; urinary tract infection; comorbidity; recurrent disease; surgical mortality; kaplan meier method; postmenopause; uterus cancer; wound infection; perioperative complication; ileus; uterus; uterine cancer; uterine cervix; female genital tract tumor; caucasian; vulvar cancer; cervical cancer; hormone substitution; hispanic; hydronephrosis; colostomy; perioperative care; urosepsis; asian; female genital tract cancer; ambulatory surgery; squamous cell; pelvis abscess; pelvic exenteration; vagina cancer; digestive system fistula; vulva; ileal conduit; exenteration; vaginal cancer; very elderly; human; female; article; black person; cystovaginal fistula; brunschwig's operation
Journal Title:	Gynecologic Oncology
Volume:	167
Issue:	2
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2022-11-01
Start Page:	277
End Page:	282
Language:	English
DOI:	10.1016/j.ygyno.2022.08.017
PUBMED:	36064678
PROVIDER:	scopus
PMCID:	PMC10204127
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85138515481&doi=10.1016%2fj.ygyno.2022.08.017&partnerID=40&md5=1f938b88152f6906f81d4a0b3b9d0993
Notes:	Article -- Export Date: 1 December 2022 -- Source: Scopus