Resecting Beyond the Central Pelvic Compartment in Pelvic Exenterations for Gynaecological Malignancies: Outcomes...

Pelvic exenterations (PE) in solid organ gynaecological malignancies have historically been confined to the central pelvic compartment but an expansion of resection extent to include the lateral compartment is now technically feasible. There remains uncertainty about its influence on outcomes.

Retrospective study of consecutive patients undergoing PE for non-ovarian gynaecological malignancies in a tertiary referral unit. Two groups were assessed and compared: standard resections including but not beyond the pelvic sidewall (SR); and extended resections beyond the pelvic side wall (lateral compartment excisions; internal iliac vessels and/or obturator internus/piriformis resection and/or bone resection) (ER).

Thirty-one patients underwent 32 PE: of these, 21 patients underwent SR (65.6%) with 11 who underwent ER (34.4%). Clear microscopic resection margins (R0) were achieved in 72.7% for ER versus 90.5% for SR. The overall 30-day major complication rate (≥Clavien-Dindo III) was 45.5% for the ER group versus 19.9% for SR. Median length-of-stay for ER was longer than for SR (38 vs. 18.5 days). The 1-year DFS for ER was 66.7% versus 77.8% for SR. The 2-year DFS for ER group was 60% versus 57.1% for SR.

In this study of contemporary patients, the short-term patient outcomes of ER were consistent with other similar cohorts in the literature and comparable to SR in this cohort. There is an urgent need for larger multicentre studies to clarify the influence of PE resectional extent on resection margin status, patient outcomes and survival.