Pelvic exenteration with curative intent for recurrent uterine malignancies
Pelvic exenteration with curative intent for recurrent uterine malignancies
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DOI：
10.1016/j.ygyno.2011.09.031
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发表时间：
2012-01-01
影响因子：
4.7
通讯作者：
Chi, Dennis S.
中科院分区：
文献类型：
--
作者：
Khoury-Collado, Fady;Einstein, M. Heather;Chi, Dennis S.
目标。目的：评价盆腔清扫术治疗现代复发性子宫恶性肿瘤的疗效。我们回顾了1997年1月1日至2011年3月3日期间在我们机构接受此手术的所有患者的记录。分析术后至90d的并发症，并按本机构分级标准进行分级。生存估计采用Kaplan-Meier方法。在研究期间，确认了21名患者。摘除时的中位年龄为57岁(范围36-75岁)。肿瘤的平均大小为6厘米(范围，显微镜下-14.5)。肿瘤组织学类型：子宫内膜样瘤10例，混合性浆液性癌肉瘤7例，肉瘤4例。全组14例，前组6例，后组1例。无术中或术后死亡。7名患者(33%)出现至少一种二级并发症，10名患者(48%)至少出现一种三级并发症。术后90天内有5例(24%)患者需要再次手术。术后中位随访时间为39个月(范围5-112个月)。整个队列的5年生存率为40%(95%可信区间：18-63)。在子宫内膜样瘤和肉瘤患者中观察到生存率提高(5年生存率分别为50%和66%)。盆腔侧壁受累和/或肾积水对患者的生存无不良影响。盆腔清扫术治疗复发性子宫恶性肿瘤可能与适当选择的患者的长期生存有关。术后并发症的高发生率仍然是该手术的一个特点，应与面临这一决定的患者仔细讨论。(C)2011 Elsevier Inc.保留所有权利。
Objective. To evaluate the outcomes observed with pelvic exenteration with curative intent for recurrent uterine malignancies in the modern era.Methods. We reviewed the records of all patients who underwent this procedure at our institution between 1/1997 and 03/2011. Postoperative complications up to 90 days after surgery were analyzed and graded as per our institution grading system. Survivals were estimated using the Kaplan-Meier method.Results. During the study period, 21 patients were identified. Median age at the time of exenteration was 57 years (range, 36-75). Median tumor size was 6 cm (range, microscopic - 14.5). Tumor histology was: endometrioid, 10 cases; mixed, serous, and carcinosarcoma, 7 cases; and sarcomas, 4 cases. The type of exenteration was: total, 14 cases; anterior, 6 cases and posterior, 1 case. There were no intra- or postoperative mortalities. Seven patients (33%) developed at least one grade 2 complication, and 10 patients (48%) developed at least one grade 3 complication. Five (24%) patients had to be re-operated on in the first 90 days post surgery. The median follow up time after exenteration was 39 months (range, 5-112). The 5-year survival of the entire cohort was 40% (95% CI: 18-63). An improved survival was observed in patients with endometrioid tumors and sarcomas (5-year survival rates of 50% and 66%, respectively). The presence of pelvic sidewall involvement and/or hydronephrosis did not negatively affect survival.Conclusion. Pelvic exenteration for recurrent uterine malignancies can be associated with long-term survival in properly selected patients. A high rate of postoperative complications remains a hallmark of this procedure and should be discussed carefully with patients facing this decision. (C) 2011 Elsevier Inc. All rights reserved.