Article Text

Download PDFPDF

2022-RA-1341-ESGO Minimally invasive versus open pelvic exenterationin gynecological malignancies: a propensity-matched survival analysis
  1. Nicolò Bizzarri1,
  2. Vito Chiantera2,
  3. Matteo Loverro1,
  4. Giulio Sozzi2,
  5. Emanuele Perrone1,
  6. Salvatore Gueli Alletti1,
  7. Barbara Costantini1,
  8. Valerio Gallotta1,
  9. Lucia Tortorella1,
  10. Anna Fagotti1,
  11. Francesco Fanfani1,
  12. Alfredo Ercoli3,
  13. Giovanni Scambia1 and
  14. Giuseppe Vizzielli4
  1. 1UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
  2. 2Unit of Gynecologic Oncology, ARNAS ‘Civico – Di Cristina – Benfratelli’, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
  3. 3Department of Human Pathology of Adult and Childhood ‘G. Barresi’, Unit of Gynecology and Obstetrics, University of Messina, Messina, Italy
  4. 4Department of Obstetrics, Gynecology, and Pediatrics, Obstetrics and Gynecology Unit, Udine University Hospital, DAME, Udine, Italy


Introduction/Background The primary endpoint of the present study was to compare the disease-free survival (DFS) of patients undergoing open versus minimally invasive pelvic exenteration (PE). Secondary endpoints cancer-specific survival (CSS) and peri-operative morbidity.

Methodology Multi-center, retrospective, observational cohort study. Patients undergoing anterior or total PE for gynecological cancer by minimally invasive and open approach between 2010–2021 were included. Positive para-aortic/inguinal lymph nodes and with distant metastases were excluded. A 1:2 propensity match analysis between patients undergoing minimally invasive and open PE was performed to equalized baseline characteristics.

Results 117 patients were included, 78 (66.7%) and 39 (33.3%) in the open and minimally invasive group, respectively. No significant difference in intra- and post-operative complications was evident between the two study groups (trend toward higher incidence of complications in open approach patients). Patients undergoing open PE received higher number of intra-operative transfusions (p=0.013). Median DFS was 17.0 months versus 17.0 months in open versus minimally invasive group, respectively (p=0.632). Median CSS was 30.0 months versus 26.0 months in open versus minimally invasive group, respectively (p=0.800). Positive surgical margins at final histology was the only significant factor influencing the risk of recurrence (HR:2.378, 95%CI 1.313–4.308) (p=0.004), while tumor diameter ≥50 mm at time of PE was the only significant factor influencing the risk of death (HR:1.833, 95%CI 1.080–3.111) (p=0.025).

Conclusion No survival difference was evident when minimally invasive was compared to open PE in patients with gynecological cancer. No difference in peri-operative complications, but higher intra-operative transfusion rate in open group, was evident.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.