Pelvic Exenteration for Advanced Nonrectal Pelvic Malignancy PelvExCollaborative

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dc.contributor.authorKelly, M.E.
dc.contributor.authorRyan, E.J.
dc.contributor.authorAalbers, A.G.J.
dc.contributor.authorAbdul, A.N.
dc.contributor.authorAbraham-Nordling, M.
dc.contributor.authorAlberda, W.
dc.contributor.authorAntoniou, A.
dc.contributor.authorAustin, K.K.
dc.contributor.authorBaker, R.
dc.contributor.authorBali, M.
dc.contributor.authorBaseckas, G.
dc.contributor.authorBednarski, B.K.
dc.contributor.authorBeets, G.L.
dc.contributor.authorBerg, P.L.
dc.contributor.authorBeynon, J.
dc.contributor.authorBiondo, S.
dc.contributor.authorBordeianou, L.
dc.contributor.authorBremers, A.B.
dc.contributor.authorBrunner, M.
dc.contributor.authorBuchwald, P.
dc.contributor.authoret al.
dc.date.issued2019
dc.description.abstractObjective: To determine factors associated with outcomes following pelvic exenteration for advanced nonrectal pelvic malignancy. Background: The PelvEx Collaborative provides large volume data from specialist centers to ascertain factors associated with improved outcomes. Methods: Consecutive patients who underwent pelvic exenteration for nonrectal pelvic malignancy between 2006 and 2017 were identified from 22 tertiary centers. Patient demographics, neoadjuvant therapy, histopathological assessment, length of stay, 30-day major complication/mortality rate were recorded. The primary endpoints were factors associated with survival. The secondary endpoints included the difference in margin rates across the cohorts, impact of neoadjuvant treatment on survival, associated morbidity, and mortality. Results: One thousand two hundred ninety-three patients were identified. 40.4% (n ¼ 523) had gynecological malignancies (endometrial, ovarian, cervical, and vaginal), 35.7% (n ¼ 462) urological (bladder), 18.1% (n ¼ 234) anal, and 5.7% had sarcoma (n ¼ 74). The median age across the cohort was 63 years (range, 23–85). The median 30-day mortality rate was 1.7%, with the highest rates occurring following exenteration for recurrent sarcoma or locally advanced cervical cancer (3.3% each). The median length of hospital stay was 17.5 days. 34.5% of patients experienced a major complication, with highest rate occurring in those having salvage surgery for anal cancer. Multivariable analysis showed R0 resection was the main factor associated with long-term survival. The 3-year overall-survival rate for R0 resection was 48% for endometrial malignancy, 40.6% for ovarian, 49.4% for cervical, 43.8% for vaginal, 59% for bladder, 48.3% for anal, and 48.1% for sarcoma. Conclusion: Pelvic exenteration remains an important treatment in selected patients with advanced or recurrent nonrectal pelvic malignancy. The range in 3-year overall survival following R0 resection (40%–59%) reflects the diversity of tumor types.
dc.description.statementofresponsibilityPelvExCollaborative: Kelly ME ... Kroon, H ... Sammour, T ... et al.
dc.identifier.citationAnnals of Surgery, 2019; 270(5):899-905
dc.identifier.doi10.1097/SLA.0000000000003533
dc.identifier.issn0003-4932
dc.identifier.issn0003-4932
dc.identifier.orcidKroon, H. [0000-0002-8923-7527]
dc.identifier.orcidSammour, T. [0000-0002-4918-8871]
dc.identifier.urihttps://hdl.handle.net/2440/140329
dc.language.isoen
dc.publisherWolters Kluwer Health
dc.rights© 2019 Wolters Kluwer Health, Inc. All rights reserved.
dc.source.urihttps://doi.org/10.1097/sla.0000000000003533
dc.subjectinternational collaboration; pelvic exenteration; pelvic malignancy; surgical outcomes; survival outcomes
dc.subject.meshHumans
dc.subject.meshPelvic Neoplasms
dc.subject.meshNeoplasm Invasiveness
dc.subject.meshNeoplasm Recurrence, Local
dc.subject.meshNeoplasm Staging
dc.subject.meshPrognosis
dc.subject.meshDisease-Free Survival
dc.subject.meshPelvic Exenteration
dc.subject.meshCause of Death
dc.subject.meshProportional Hazards Models
dc.subject.meshRisk Assessment
dc.subject.meshSurvival Analysis
dc.subject.meshRetrospective Studies
dc.subject.meshCohort Studies
dc.subject.meshDatabases, Factual
dc.subject.meshAged
dc.subject.meshAged, 80 and over
dc.subject.meshMiddle Aged
dc.subject.meshFemale
dc.subject.meshKaplan-Meier Estimate
dc.subject.meshTertiary Care Centers
dc.titlePelvic Exenteration for Advanced Nonrectal Pelvic Malignancy PelvExCollaborative
dc.typeJournal article
pubs.publication-statusPublished

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