A Prospective Observational Cohort Study Comparing High-Complexity Against Conventional Pelvic Exenteration Surgery.

Area of Science:

• Surgical Oncology
• Pelvic Reconstruction
• Cancer Treatment Outcomes

Background:

• Conventional pelvic exenteration (PE) is a standard treatment for pelvic cancers.
• Tumors involving bone or lateral sidewall structures were previously considered inoperable.
• High-complexity PE extends conventional PE to include resection of bone or pelvic sidewall structures for advanced tumors.

Purpose of the Study:

• To assess surgical outcomes, health-related quality of life (HrQoL), decision regret, and costs of high-complexity PE.
• To compare high-complexity PE with conventional PE for advanced pelvic tumors.
• To evaluate the cost-effectiveness of high-complexity PE against no surgery.

Main Methods:

• Observational cohort study using prospectively maintained quaternary database.
• Inclusion of 319 cases: 64 conventional PE and 255 high-complexity PE.
• Primary outcome: overall survival. Secondary outcomes: perioperative mortality, disease control, major morbidity, HrQoL, health resource use, and cost-utility analysis.

Main Results:

• Overall survival was equivalent between conventional and high-complexity PE (median 10.5 vs. 9.8 years).
• Local control, 90-day mortality, R0-resection rates, 12-month HrQoL, and decision regret were comparable.
• High-complexity PE significantly increased major morbidity (16% vs. 31%) and perioperative costs (GBP 37,271 vs. GBP 45,733).

Conclusions:

• High-complexity PE is a safe and feasible surgical option for advanced pelvic tumors.
• It provides comparable survival outcomes and HrQoL to conventional PE.
• Despite increased morbidity and costs, high-complexity PE demonstrates cost-effectiveness compared to no surgery or palliation.