Development and External Validation of a Prognostic Staging System for Predicting Wound Complication after Internal...

Area of Science:

• Oncology
• Surgical Oncology
• Reconstructive Surgery

Background:

• Internal hemipelvectomy (IHP) is a complex oncologic surgery.
• Wound healing complications are a significant challenge post-IHP.
• Preoperative risk assessment is crucial for surgical planning and complication reduction.

Purpose of the Study:

• To develop and validate a preoperative risk stratification model for wound complications after IHP.
• To identify key predictors of surgical site complications.
• To stratify patients into distinct risk categories for targeted management.

Main Methods:

• Retrospective review of 411 patients undergoing en bloc internal hemipelvectomy for pelvic tumors (1996-2018).
• Data from a U.S. training set (N=123) and international validation set (N=288) were analyzed.
• Logistic regression identified predictors; a risk score incorporated resection type and tumor extension, creating low, intermediate, and high-risk groups.

Main Results:

• Wound complications requiring intervention occurred in 34% (training) and 35% (validation) of patients.
• Wound complication rates varied significantly across risk groups: low (7.1-7.4%), intermediate (32-40%), and high (49-67%) (p<0.001).
• The model showed fair-to-good discriminative performance (AUC 0.71-0.83) across diverse patient cohorts.

Conclusions:

• The first externally validated prognostic staging system for predicting wound complications post-IHP is presented.
• The model is simple, reproducible, and clinically applicable for preoperative risk identification.
• High-risk patients may benefit from modified surgical approaches or prophylactic reconstruction; further studies are needed for intermediate/high-risk management.