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Factors Predictive of 90-Day Morbidity, Readmission, and Costs in Patients Undergoing Pelvic Exenteration
  1. Giorgio Bogani, MD, PhD*,
  2. Mauro Signorelli, MD*,
  3. Antonino Ditto, MD*,
  4. Fabio Martinelli, MD*,
  5. Jvan Casarin, MD,
  6. Lavinia Mosca, MD*,
  7. Umberto Leone Roberti Maggiore, MD*,
  8. Valentina Chiappa, MD*,
  9. Domenica Lorusso, MD, PhD* and
  10. Francesco Raspagliesi, MD*
  1. * Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy; and
  2. Gynecologic Surgery, Mayo Clinic, Rochester, MN.
  1. Address correspondence and reprint requests to Lavinia Mosca, MD, Department of Gynecologic Oncology, IRCCS National Cancer Institute, Via Venezian 1, 20133 Milan, Italy. E-mail: lavinia.mosca{at}istitutotumori.mi.it; or laviniamosca{at}aol.it.

Abstract

Objective Pelvic exenteration for recurrent gynecological malignancies is characterized by a high rate of severe complications. Factors predictive of morbidity, readmission, and cost were analyzed.

Methods Data of consecutive patients undergoing pelvic exenteration between January 2007 and December 2016 were prospectively evaluated.

Results Fifty-eight patients were included in the analysis. Anterior, posterior, and total exenterations were executed in 39 (67%), 9 (16%), and 10 (17%) patients, respectively. Ten (15.5%) severe complications occurred: 8 (20.5%), 0 (0%), and 1 (10%) after anterior, posterior, and total exenterations, respectively. Radiotherapy dosage, time between radiotherapy and surgery, and previous administration of chemotherapy did not influence 90-day complications and readmission. At multivariable analysis, albumin levels less than 3.5 g/dL (odds ratio, 16.2 [95% confidence interval, 2.85–92.8]; P = 0.002) and history of deep vein thrombosis (odds ratio, 9.6 [95% confidence interval, 0.93–98.2]; P = 0.057) were associated with 90-day morbidity. Low albumin levels independently correlated with readmission (P = 0.011). The occurrence of 90-day postoperative complications and readmission increased costs of a median of +12,500 and +6000 euros, respectively (P < 0.05).

Conclusions Preoperative patient selection is a key point for the reduction of postoperative complications after pelvic exenteration. Further prospective studies are warranted to improve patient selection.

  • Exenteration
  • Recurrent gynecological malignancies
  • Salvage surgery
  • Morbidity
  • Costs

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Footnotes

  • The authors declare no conflicts of interest.

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