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. 2022 Nov;167(2):277-282.
doi: 10.1016/j.ygyno.2022.08.017. Epub 2022 Sep 3.

A modern-day experience with Brunschwig's operation: Outcomes associated with pelvic exenteration

Eric Rios-Doria  1 , Olga T Filippova  1 , Alli M Straubhar  1 , Andrew Chi  1 , Ibraheem Awowole  2 , Jaspreet Sandhu  3 , Vance Broach  4 , Jennifer J Mueller  4 , Ginger J Gardner  4 , Elizabeth L Jewell  4 , Oliver Zivanovic  4 , Mario M Leitao Jr  4 , Kara Long Roche  4 , Nadeem R Abu-Rustum  4 , Yukio Sonoda  5
Affiliations

A modern-day experience with Brunschwig's operation: Outcomes associated with pelvic exenteration

Eric Rios-Doria et al. Gynecol Oncol. 2022 Nov.

Abstract

Objective: To evaluate postoperative and oncologic outcomes associated with pelvic exenteration for non-ovarian gynecologic malignancies.

Methods: This was a retrospective review of patients who underwent pelvic exenteration for non-ovarian gynecologic malignancies at our institution from 1/1/2010-12/31/2019. Palliative exenteration cases were excluded from survival analysis. Postoperative complications were early (≤30 days) or late (31-180 days). Complications were graded using a validated institutional scale. Major complications were considered grade ≥ 3. Categorical variables were compared using the chi-square test, and the Kaplan-Meier method was used for survival analysis.

Results: Of 100 patients identified, 89 underwent pelvic exenteration for recurrent disease, 5 for palliation, 5 for primary disease, and 1 for persistent disease. Thirty percent had cervical, 27% vulvar, 24% uterine, and 19% vaginal cancer. Sixty-two percent underwent total, 30% anterior, and 8% posterior exenteration. No deaths occurred intraoperatively or within 30 days of surgery. Six patients died after 30 days. Ninety-seven experienced a perioperative complication-49 early, 1 late, and 47 both. Fifty experienced a major complication-22 (44%) early, 19 (38%) late, and 9 (18%) both. No variables were statistically associated with complication development. The 3-year progression-free survival rate was 61.0%; the 3-year overall survival rate was 61.6%. Of 58 surviving patients, 16 (28%) and 4 (7%) were alive after 5 and 10 years, respectively.

Conclusion: The overall complication rate for pelvic exenteration remains high. No variables demonstrated association with complication development as the rate was nearly 100%. The low rate of perioperative mortality is likely due to improved perioperative care.

Keywords: Brunschwig's operation; Cervical cancer; Pelvic exenteration; Uterine cancer; Vaginal cancer; Vulvar cancer.

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Conflict of interest statement

Declaration of Competing Interest Dr. Leitao is an ad hoc speaker for Intuitive Surgical, Inc.; outside the submitted work, he is on the Advisory Board of Ethicon/Johnson & Johnson and Takeda; and reports grants paid to the institution by KCI/Acelity. Dr. Abu-Rustum reports research funding paid to the institution by GRAIL; and Dr. Jewell reports personal fees from Covidien/Medtronic. The other authors do not have potential conflicts of interest to declare.

Figures

Figure 1.
Figure 1.. Progression-free survival for non-palliative pelvic exenterations.
PFS, progression-free survival
Figure 2.
Figure 2.. Overall survival for non-palliative pelvic exenterations.
OS, overall survival
See this image and copyright information in PMC

References

    1. Brunschwig A. The surgical treatment of cancer of the cervix uteri; a radical operation for cancer of the cervix. Bull N Y Acad Med 1948;24:672–83. - PMC - PubMed
    1. Brunschwig A. Complete excision of pelvic viscera for advanced carcinoma; a one-stage abdominoperineal operation with end colostomy and bilateral ureteral implantation into the colon above the colostomy. Cancer 1948;1:177–83. doi:10.1002/1097-0142(194807)1:2<177::aid-cncr2820010203>3.0.co;2-a. - DOI - PubMed
    1. Kaur M, Joniau S, D’Hoore A, Vergote I. Indications, techniques and outcomes for pelvic exenteration in gynecological malignancy. Curr Opin Oncol 2014;26:514–20. doi:10.1097/CCO.0000000000000109. - DOI - PubMed
    1. Andikyan V, Khoury-Collado F, Sonoda Y, Gerst SR, Alektiar KM, Sandhu JS, et al. Extended pelvic resections for recurrent or persistent uterine and cervical malignancies: an update on out of the box surgery. Gynecol Oncol 2012;125:404–8. doi:10.1016/j.ygyno.2012.01.031. - DOI - PubMed
    1. Khoury-Collado F, Einstein MH, Bochner BH, Alektiar KM, Sonoda Y, Abu-Rustum NR, et al. Pelvic exenteration with curative intent for recurrent uterine malignancies. Gynecol Oncol 2012;124:42–7. doi:10.1016/j.ygyno.2011.09.031. - DOI - PubMed

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