J Gynecol Oncol.  2024 Jan;35(1):e4. 10.3802/jgo.2024.35.e4.

Predictive factors of surgical complications after pelvic exenteration for gynecological malignancies: a large single-institution experience

• Tortorella L
• Marco C
• Loverro M
• Carmine C
• Persichetti E
• Bizzarri N
• Barbara C
• Francesco S
• Foschi N
• Gallotta V
• Avesani G
• Chiantera V
• Ercoli A
• Fanfani F
• Fagotti A
• Mele MC
• Restaino S
• Alletti SG
• Scambia G
• Vizzielli G

• KMID: 2564866
• DOI: http://doi.org/10.3802/jgo.2024.35.e4

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.

Keyword

Cervical Cancer; Endometrial Cancer; Pelvic Exenteration; Nutritional Status