J Gynecol Oncol.  2024 Mar;35(2):e12. 10.3802/jgo.2024.35.e12.

Robotic or laparoscopic pelvic exenteration for gynecological malignancies: feasible options to open surgery

• Dudus L
• Minciuna C
• Tudor S
• Lacatus M
• Stefan B
• Vasilescu C

• KMID: 2564872
• DOI: http://doi.org/10.3802/jgo.2024.35.e12

Abstract

Objective
To acknowledge that minimally invasive pelvic exenteration is a feasible alternative to open surgery and potentially identify prediction factors for patient outcome.
Methods
The study was designed as a retrospective single team analysis of 12 consecutive cases, set between January 2008 and January 2022.
Results
Six anterior and 6 total pelvic exenterations were performed. A 75% of cases were treated using a robotic approach. In 4 cases, an ileal conduit was used for urinary reconstruction. Mean operative time was 360±30.7 minutes. for anterior pelvic exenterations and 440±40.7 minutes. for total pelvic exenterations and mean blood loss was 350±35 mL. An R0 resection was performed in 9 cases (75%) and peri-operative morbidity was 16.6%, with no deaths recorded. Median disease-free survival was 12 months (10–14) and overall survival (OS) was 20 months (1–127). In terms of OS, 50% of patients were still alive 24 months after surgery. Taking into consideration the follow up period,16.6% of females under 50 or above 70 years old did not reach the cut off and 4 out of 6 patients that failed to reach it were diagnosed with distant metastases or local recurrence (p=0.169).
Conclusion
Our experience is very much consistent with literature in regard to primary site of cancer, post-operative complications, R0 resection and survival rates. On the other hand, minimally invasive approach and urinary reconstruction type were in contrast with cited publications. Minimally invasive pelvic exenteration is indeed a safe and feasible procedure, providing patients selection is appropriately performed.

Keyword

Minimally Invasive Surgery; Pelvic Exenteration; Gynecologic Neoplasm; Cervical Cancer