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- Title
Predictive factors of surgical complications after pelvic exenteration for gynecological malignancies: a large single-institution experience.
- Authors
Tortorella, Lucia; Marco, Cintoni; Loverro, Matteo; Carmine, Conte; Persichetti, Eleonora; Bizzarri, Nicolò; Barbara, Costantini; Francesco, Santullo; Foschi, Nazario; Gallotta, Valerio; Avesani, Giacomo; Chiantera, Vito; Ercoli, Alfredo; Fanfani, Francesco; Fagotti, Anna; Mele, Maria Cristina; Restaino, Stefano; Alletti, Salvatore Gueli; Scambia, Giovanni; Vizzielli, Giuseppe
- 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.
- Subjects
PELVIC exenteration; SURGICAL complications; VAGINAL cancer; URINARY diversion; ODDS ratio; GYNECOLOGIC care; PELVIC examination
- Publication
Journal of Gynecologic Oncology, 2024, Vol 35, Issue 1, p1
- ISSN
2005-0380
- Publication type
Article
- DOI
10.3802/jgo.2024.35.e4