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  • Comparison of postoperative complications and quality of life between patients undergoing continent versus non-continent urinary diversion after pelvic exenteration for gynecologic malignancies

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Original research
Comparison of postoperative complications and quality of life between patients undergoing continent versus non-continent urinary diversion after pelvic exenteration for gynecologic malignancies
  1. Martina Aida Angeles1,
  2. Estelle Mallet2,
  3. Philippe Rouanet3,
  4. Bastien Cabarrou4,
  5. Pierre Méeus5,
  6. Eric Lambaudie6,
  7. Fabrice Foucher7,
  8. Fabrice Narducci8,
  9. Cécile Loaec9,
  10. Sebastien Gouy10,
  11. Frederic Guyon11,
  12. Frédéric Marchal12,
  13. Laurence Gladieff13,
  14. Carlos Martínez-Gómez1,14,
  15. Federico Migliorelli15,
  16. Alejandra Martinez14,16 and
  17. Gwenael Ferron16,17
  1. 1 Surgical Oncology, Institut Claudius Regaud IUCT-oncopole, Toulouse, Occitanie, France
  2. 2 Surgical Oncology, Centre Antoine-Lacassagne, Nice, Provence-Alpes-Côte d'Azu, France
  3. 3 Department of Surgical Oncology, Institut régional du Cancer de Montpellier, Montpellier, France
  4. 4 Biostatistics Unit, Institut Claudius Regaud, Toulouse, Occitanie, France
  5. 5 Department of Surgical Oncology, Institut Léon Bérard, Lyon, France
  6. 6 Institut Paoli-Calmettes, Marseille, France
  7. 7 Department of Surgical Oncology, Centre Eugene Marquis, Rennes, Bretagne, France
  8. 8 Gynecology, Centre Oscar Lambret, lille, France
  9. 9 Institut de Cancerologie de l'Ouest, Nantes, France
  10. 10 Institut Gustave-Roussy, Villejuif, Île-de-France, France
  11. 11 Institut Bergonie, Bordeaux, France
  12. 12 Surgical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, Lorraine, France
  13. 13 Medical Oncology, Institut Claudius Regaud, Toulouse, Occitanie, France
  14. 14 INSERM CRCT 1, Toulouse, France
  15. 15 Department of Women, Children and Adolescents, Hopitaux Universitaires de Geneve, Geneva, Switzerland
  16. 16 Institut Claudius Regaud, Toulouse, Occitanie, France
  17. 17 INSERM CRCT 19, Toulouse, France
  1. Correspondence to Dr Gwenael Ferron, Institut Claudius Regaud, Toulouse, Occitanie 31059, France; ferron.gwenael{at}iuct-oncopole.fr

Abstract

Background Pelvic exenteration and its reconstructive techniques have been associated with high postoperative morbidity and a negative impact on patient quality of life. The aim of our study was to compare postoperative complications and quality of life in patients undergoing continent compared with non-continent urinary diversion after pelvic exenteration for gynecologic malignancies.

Methods We designed a multicenter study of patients from 10 centers who underwent an anterior or total pelvic exenteration with urinary reconstruction for histologically confirmed persistent or recurrent gynecologic malignancy after previous treatment with radiotherapy. From January 2005 to September 2008, we included patients retrospectively, and from September 2008 to May 2009, patients were included prospectively which allowed collection of quality of life data. Demographic, surgical, and follow-up data were analyzed. Postoperative complications were classified according to the Clavien–Dindo classification. Quality of life was assessed using the European Organization for Research and Treatment of Cancer (EORTC)-QLQ-C30 (V.3.0) and EORTC-QLQ-OV28 quality of life questionnaires. We compared patients who underwent a continent urinary diversion with those who underwent a non-continent reconstruction.

Results We included 148 patients, 92 retrospectively and 56 prospectively. Among them, 77.4% had recurrent disease and 22.6% persistent disease after the primary treatment. In 70 patients, a urinary continent diversion was performed, and 78 patients underwent a non-continent diversion. Median age of the continent and incontinent groups was 53.5 (range 33–78) years and 57 (26-79) years, respectively. There were no significant differences between the continent and non-continent groups in median length of hospitalization (28.5 vs 26 days, P=0.19), postoperative grade III–IV complications (42.9% vs 42.3%, P=0.95), complications needing surgical (27.9% vs 34.6%, P=0.39) or radiological (14.7% vs 12.8%, P=0.74) intervention, and complication type (digestive (23.2% vs 16.7%, P=0.32) and urinary (15.9% vs 16.7%, P=0.91)). There were no significant differences between the groups in global health, global quality of life, and body image perception scores 1 year after surgery.

Conclusion Continent and incontinent urinary reconstructions are equivalent in terms of postoperative complications and quality of life scores.

  • gynecologic cancer
  • anterior pelvic exenteration
  • continent urinary reconstruction
  • incontinent urinary reconstruction
  • global health
  • body image

https://doi.org/10.1136/ijgc-2019-000863

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    Footnotes

    • MAA and EM are joint first authors.

    • AM and GF are joint senior authors.

    • Twitter @AngelesFite, @Alejandra

    • Contributors MAA: conceptualization, data curation, methodology, and writing–original draft. EM: conceptualization, data curation, methodology, and writing–original draft. PR: conceptualization, project administration, and methodology writing–review. BC: conceptualization, data curation, methodology, statistical analyses, and writing–review. PM: conceptualization, project administration, and methodology writing–review. EL: conceptualization, project administration, and methodology writing–review. FF: conceptualization, project administration, and methodology writing– review. FN: conceptualization, project administration, and methodology writing–review. CL: conceptualization, project administration, and methodology writing–review. SG: conceptualization, project administration, and methodology writing– review. FG: conceptualization, project administration, and methodology writing–review. FM: conceptualization, project administration, and methodology writing–review. LG: conceptualization, project administration, and methodology writing– review. CM-G: conceptualization, data curation, methodology, and writing–original draft. FM: conceptualization, data curation, methodology, and writing–original draft. AM: conceptualization, project administration, and methodology writing–review. GF: conceptualization, project administration, and methodology writing– review.

    • Funding This study was supported by a grant from the French Ministry of Health (STIC (support for innovative and expensive techniques), 2007, Exenteration pelvienne).

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Ethics approval Institutional review board approval was obtained from all centers.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.