Minimally invasive versus open pelvic exenteration in gynecological malignancies: a propensity-matched survival analysis. Issue 2 (2nd January 2023)

• Record Type: Journal Article
• Authors: Bizzarri, Nicolò; Chiantera, Vito; Loverro, Matteo; Sozzi, Giulio; Perrone, Emanuele; Gueli Alletti, Salvatore; Costantini, Barbara; Gallotta, Valerio; Tortorella, Lucia; Fagotti, Anna; Fanfani, Francesco; Ercoli, Alfredo; Scambia, Giovanni; Vizzielli, Giuseppe
• Is Part Of: International journal of gynecological cancer. Volume 33:Issue 2(2023)
• Page Start: 190
• Page End: 197
• Publication Date: 2023-01-02
• Subjects: neoplasm recurrence, local -- surgical oncology -- laparoscopes -- laparotomy -- postoperative care; Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1136/ijgc-2022-003954
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : 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.