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

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

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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.

Original languageEnglish
JournalAnnals of Surgical Oncology
DOIs
Publication statusAccepted/In press - Jan 1 2018

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Neoplasms
Morbidity
Recurrence
Survival
Blood Vessels
Radiotherapy
Bone and Bones
Muscles

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Laterally Extended Pelvic Resection for Gynaecological Malignancies : A Multicentric Experience with Out-of-the-Box Surgery. / Vizzielli, Giuseppe; Naik, Raj; Dostalek, Lukas; Bizzarri, Nicolò; Kucukmetin, Ali; Tinelli, Giovanni; Scambia, Giovanni; Cibula, David.

In: Annals of Surgical Oncology, 01.01.2018.

Research output: Contribution to journalArticle

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title = "Laterally Extended Pelvic Resection for Gynaecological Malignancies: A Multicentric Experience with Out-of-the-Box Surgery",
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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T1 - Laterally Extended Pelvic Resection for Gynaecological Malignancies

T2 - A Multicentric Experience with Out-of-the-Box Surgery

AU - Vizzielli, Giuseppe

AU - Naik, Raj

AU - Dostalek, Lukas

AU - Bizzarri, Nicolò

AU - Kucukmetin, Ali

AU - Tinelli, Giovanni

AU - Scambia, Giovanni

AU - Cibula, David

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N2 - 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.

AB - 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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