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
- postoperative care
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.
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