Predictive factors of surgical complications after pelvic exenteration for gynecological malignancies: a large single-institution experience
- Author:
Lucia TORTORELLA
1
;
Cintoni MARCO
;
Matteo LOVERRO
;
Conte CARMINE
;
Eleonora PERSICHETTI
;
Nicolò BIZZARRI
;
Costantini BARBARA
;
Santullo FRANCESCO
;
Nazario FOSCHI
;
Valerio GALLOTTA
;
Giacomo AVESANI
;
Vito CHIANTERA
;
Alfredo ERCOLI
;
Francesco FANFANI
;
Anna FAGOTTI
;
Maria Cristina MELE
;
Stefano RESTAINO
;
Salvatore Gueli ALLETTI
;
Giovanni SCAMBIA
;
Giuseppe VIZZIELLI
Author Information
- Publication Type:Original Article
- From:Journal of Gynecologic Oncology 2024;35(1):e4-
- CountryRepublic of Korea
- Language:English
-
Abstract:
Objective:To evaluate pre-operative predictors of early (<30 days) severe complications (grade Dindo 3+) in patients with gynecological malignancy submitted to pelvic exenteration (PE).
Methods:We retrospectively analyzed 129 patients submitted to surgery at Fondazione Policlinico Gemelli between 2010 and 2019. We included patients affected by primary or recurrent/persistent cervical, endometrial, or vulvar/vaginal cancers. Post-operative complications were graded according to the Dindo classification. Logistic regression was used to analyze potential predictors of complications.
Results:We performed 63 anterior PE, 10 posterior PE, and 56 total PE. The incidence of early severe post-operative complications was 27.9% (n=36), and the early mortality rate was 2.3% (n=3). More frequent complications were related to the urinary diversion and intestinal surgery. In univariable analysis, hemoglobin ≤10 g/dL (odds ratio [OR]=4.2; 95% confidence interval [CI]=1.65–10.7; p=0.003), low albumin levels (OR=3.9; 95% CI=1.27–12.11; p=0.025), diabetes (OR=4.15; 95% CI=1.22–14.1; p=0.022), 2+ comorbidities at presentation (OR=5.18;95% CI=1.49–17.93; p=0.012) were predictors of early severe complications. In multivariable analysis, only low hemoglobin and comorbidities at presentation were independent predictors of complications.
Conclusion:Pelvic exenteration is an aggressive surgery characterized by a high rate of postoperative complications. Pre-operative assessment of comorbidities and patient health status are crucial to better select the right candidate for this type of surgery.
