Minimally-invasive pelvic exenteration: a survival analysis.
Introduction/Background*Pelvic exenteration for recurrent and persistent gynecological malignancies is traditionally performed with open approach (OA). Nevertheless, reports on the use of minimally-invasive surgical (MIS) approach to pelvic exenteration have been published with promising results in terms of peri-operative morbidity. However, oncological safety of this approach has been poorly investigated. The aim of the present study was to assess the disease-free survival (DFS) and overall survival (OS) of patients undergoing minimally-invasive pelvic exenteration.
Methodology All patients undergoing pelvic exenteration for gynecological cancers between 2010 and 2021 were included and divided into minimally invasive and open pelvic exenterations. Only patients who underwent OA with maximum tumor diameter ≤50 mm were included in order to balance characteristics of the two groups. Survival analysis was performed according to Kaplan Meier methods and log-rank test; multivariate analysis was performed with Cox regression.
Result(s)*Eighty-three patients were included. 35 (42.2%) were in the MIS and 48 (57.8%) in the OA group. 21 (60.0%) and 14 (40.0%) MIS were laparoscopic and robotic, respectively. Characteristics of the two groups are reported in table 1. Patients undergoing OA experienced a higher rate of 30-day post-operative complications ≥grade 3 (table 2). With a median follow up of 12 months (range, 1-97), the median DFS was 11 months (95%CI 8.8-13.2) versus 13 months (95%CI 0.3-25.6) for OA versus MIS, respectively (p=0.757) (figure 1). Median OS was 23 months (95%CI 15.4-30.6) versus 22 months (95%CI 7.8-37.3) for OA versus MIS, respectively (p=0.696) (figure 2). Multivariate analysis demonstrated that the presence of involved surgical margins was the only factor with significant impact on DFS, while surgical approach, grading, metastatic pelvic lymph nodes and adjuvant chemotherapy did not impact DFS.
Conclusion*MIS for pelvic exenteration showed no DFS and OS difference when compared with OA, with lower rate of major early post-operative complications.
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