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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2019

01-02-2019 | Gynecologic Oncology

Laterally Extended Pelvic Resection for Gynaecological Malignancies: A Multicentric Experience with Out-of-the-Box Surgery

Authors: Giuseppe Vizzielli, MD, PhD, Raj Naik, MD, Lukas Dostalek, MD, Nicolò Bizzarri, MD, Ali Kucukmetin, MD, Giovanni Tinelli, MD, Giovanni Scambia, MD, David Cibula, MD

Published in: Annals of Surgical Oncology | Issue 2/2019

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Abstract

Purpose

To evaluate morbidity and oncological outcome in a multicentre series of women with gynaecological malignancies infiltrating pelvic side wall (PSW) that received laterally extended pelvic resection (LEPR).

Methods

Patients operated between 2007 and 2017 at three institutions were included. LEPR was defined as an en bloc lateral resection of a pelvic tumour involving sidewall muscle, and/or bone, and/or major nerve, and/or major vascular structure. Postsurgical complications and survivals were evaluated.

Results

Sixty-three women with gynaecological tumours involving PSW were treated with LEPR. Five women underwent primary LEPR, whereas 58 (92%) patients needed LEPR because of recurrence. Twenty-four women (38%) received previous radiation therapy before the surgery. R0 resection was achieved in 54 patients (85.7%), whereas the pathologic margins were microscopically and macroscopically positive in 8 (12.7%) patients and 1 (1.6%) patient, respectively. There was one perioperative death, whereas major postoperative complications occurred in 17 patients (27.7%). Thirty (47.5%) women experienced recurrences: 24/54 (44.4%) were in the R0 group, and 6/9 (66.6%) were in the R1 group, with a median PFS of 15 months and 7 months, respectively (p = 0.024). In total, 11 of 54 (20.3%) patients died of disease in the R0 group and 5 of 9 (55.5%) in the R1 group; a median OS was not reached and was 32 months for R0 and R1 groups, respectively (p = 0.033).

Conclusions

Involvement of the PSW should not prevent obtaining R0 resection. Although the LEPR is associated with considerable morbidity (≈ 30%), a long-term survival seems to be achieved in those women with complete resection.
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Metadata
Title
Laterally Extended Pelvic Resection for Gynaecological Malignancies: A Multicentric Experience with Out-of-the-Box Surgery
Authors
Giuseppe Vizzielli, MD, PhD
Raj Naik, MD
Lukas Dostalek, MD
Nicolò Bizzarri, MD
Ali Kucukmetin, MD
Giovanni Tinelli, MD
Giovanni Scambia, MD
David Cibula, MD
Publication date
01-02-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 2/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-07088-8

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