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

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Authors and Affiliations

  1. Department of Women’s and Children’s Health, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

    Giuseppe Vizzielli MD, PhD & Giovanni Scambia MD

  2. Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK

    Raj Naik MD, Nicolò Bizzarri MD & Ali Kucukmetin MD

  3. Gynaecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague, General University Hospital in Prague, Prague, Czech Republic

    Lukas Dostalek MD & David Cibula MD

  4. Division of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

    Giovanni Tinelli MD

Authors
  1. Giuseppe Vizzielli MD, PhD
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  2. Raj Naik MD
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  3. Lukas Dostalek MD
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  4. Nicolò Bizzarri MD
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  5. Ali Kucukmetin MD
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  6. Giovanni Tinelli MD
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  7. Giovanni Scambia MD
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  8. David Cibula MD
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Corresponding author

Correspondence to Giuseppe Vizzielli MD, PhD.

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The authors have no conflicts of interest to declare.

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Vizzielli, G., Naik, R., Dostalek, L. et al. Laterally Extended Pelvic Resection for Gynaecological Malignancies: A Multicentric Experience with Out-of-the-Box Surgery. Ann Surg Oncol 26, 523–530 (2019). https://doi.org/10.1245/s10434-018-07088-8

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  • DOI: https://doi.org/10.1245/s10434-018-07088-8

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