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Minimally invasive versus open pelvic exenteration in 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 Vizzielli4,5
  1. 1UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
  2. 2Department 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. 3Unit of Gynecology and Obstetrics, Department of Human Pathology of Adult and Childhood "G. Barresi", Unit of Gynecology and Obstetrics, University of Messina, Messina, Italy
  4. 4Department of Medical Area (DAME), University of Udine, Udine, Friuli-Venezia Giulia, Italy
  5. 5Clinic of Obstetrics and Gynecology – “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
  1. Correspondence to Dr Nicolò Bizzarri, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome 00168, Italy; nicolo.bizzarri{at}


Objective The primary endpoint of this study was to compare the disease-free survival of patients undergoing open versus minimally invasive pelvic exenteration. The secondary endpoints were cancer-specific survival and peri-operative morbidity.

Methods A multi-center, retrospective, observational cohort study was undertaken. Patients undergoing curative and palliative anterior or total pelvic exenteration for gynecological cancer by a minimally invasive approach and an open approach between June 2010 and May 2021 were included. Patients with distant metastases were excluded. A 1:2 propensity match analysis between patients undergoing minimally invasive and open pelvic exenteration was performed to equalized baseline characteristics.

Results After propensity match analysis a total of 117 patients were included, 78 (66.7%) and 39 (33.3%) in the open and minimally invasive group, respectively. No significant difference in intra-operative (23.4% vs 10.3%, p=0.13) and major post-operative complications (24.4% vs 17.9%, p=0.49) was evident between the open and minimally invasive approach. Patients undergoing open pelvic exenteration received higher rates of intra-operative transfusions (41.0% vs 17.9%, p=0.013). Median disease-free survival was 17.0 months for both the open and minimally invasive groups (p=0.63). Median cancer-specific survival was 30.0 months and 26.0 months in the open and minimally invasive groups, respectively (p=0.80). Positivity of surgical margins at final histology was the only significant factor influencing the risk of recurrence (hazard ratio (HR) 2.38, 95% CI 1.31 to 4.31) (p=0.004), while tumor diameter ≥50 mm at the time of pelvic exenteration was the only significant factor influencing the risk of death (HR 1.83, 95% CI 1.08 to 3.11) (p=0.025).

Conclusion In this retrospective study no survival difference was evident when minimally invasive pelvic exenteration was compared with open pelvic exenteration in patients with gynecological cancer. There was no difference in peri-operative complications, but a higher intra-operative transfusion rate was seen in the open group.

  • neoplasm recurrence, local
  • surgical oncology
  • laparoscopes
  • laparotomy
  • postoperative care

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Presented at The results of the present work have been presented as an oral presentation at the 31st Annual Congress of the European Society of Gynecological Endoscopy (ESGE), 2-5 October 2022 in Lisbon, Portugal and as a poster presentation at the 23rd International Meeting of the European Congress on Gynaecological Oncology (ESGO 2022), 27-30 October 2022 in Berlin, Germany.

  • Contributors Conception of study: NB and GV. Design and development: NB, GV, and GSc. Data collection: ML, GSo, VC, EP, SGA, BC, VG, LT, AE, FF and AF. Data analysis: NB, GV, ML, and GSo. Preparation of tables: GV and NB. Initial draft of manuscript: NB, GV, GSc. Guarantor: NB, VC, GSc. Manuscript writing, review, and approval: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.