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Morbidity, Recurrence and Survival Following Pelvic Exenteration for Gynaecological Malignancies: A Retrospective,
Shruti Zalawadia1, Sofia Lekka1, Zahra Al-Jumaili1
1Department of Gynaecologic Oncology, Royal London Hospital, Barts Health Trust, London E1 1BB, UK.
Abstract:
Background/Objectives: We evaluated perioperative morbidity, recurrence patterns and survival outcomes following pelvic exenteration (PE) at a tertiary referral centre. Methods: A retrospective observational study was conducted in women undergoing PE from 2004 to 2024. We collected demographics, performance status (PS), comorbidities, body mass index (BMI), tumour histology, intraoperative details, postoperative morbidity (Clavien-Dindo classification), mortality, length of stay (LOS), recurrence patterns and cancer-related death. Descriptive statistics were performed alongside Kaplan-Meier survival analysis. Results: Forty-seven patients underwent PE; median PS was 0 [interquartile range (IQR) 0-0]. Median ages at diagnosis and surgery were 55 (IQR 49-66) and 60 (IQR 50-68) years, respectively, with a median follow-up of 26 months (IQR 12-64). Thirty-two procedures (68%) were performed for recurrent and N = 15 (32%) for primary disease. Histology included N = 17 endometrial (36%), N = 10 vulval (23%), ovarian (15%), N = 5 cervical (11%) and N = 7 vaginal (15%) cases. Eighteen patients (38%) underwent total PE, N = 15 (32%) anterior PE and N = 14 (30%) posterior PE. Median blood loss was 1.5 L (IQR 0.85-2.0) and median operative time was 391 mis (IQR 313-482). Median HDU stay was 4 days (IQR 2-5) and LOS was 17 days (IQR 13-31). One postoperative death occurred. Major complications (Clavien-Dindo ≥3) occurred in 15 patients (32%). Late complications occurred in n = 17 (36.2%) women. Nineteen patients (41%) remained recurrence-free; N = 4 (9%) developed local and N = 24 (51%) distant recurrence. Mean overall survival time post-surgery for curative intent PE (N = 46) was 94 months (95%CI = 57-131 months); for primary tumours this was 51.6 (95%CI = 31-72) vs. 99 (56.01-142) for recurrent disease (p > 0.05). Conclusions: Pelvic exenteration is associated with acceptable morbidity and mortality in carefully selected patients, offering excellent locoregional disease control.
