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

  • Eric Rios-Doria
    Affiliations
    Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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  • Olga T. Filippova
    Affiliations
    Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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  • Alli M. Straubhar
    Affiliations
    Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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  • Andrew Chi
    Affiliations
    Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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  • Ibraheem Awowole
    Affiliations
    Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Department of Obstetrics, Gynaecology, and Perinatology, Obafemi Awolowo University, Ife, Nigeria
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  • Jaspreet Sandhu
    Affiliations
    Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Department of Urology, Weill Cornell Medical College, New York, NY, USA
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  • Vance Broach
    Affiliations
    Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
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  • Jennifer J. Mueller
    Affiliations
    Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
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  • Ginger J. Gardner
    Affiliations
    Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
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  • Elizabeth L. Jewell
    Affiliations
    Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
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  • Oliver Zivanovic
    Affiliations
    Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
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  • Mario M. Leitao Jr
    Affiliations
    Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
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  • Kara Long Roche
    Affiliations
    Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
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  • Nadeem R. Abu-Rustum
    Affiliations
    Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
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  • Yukio Sonoda
    Correspondence
    Corresponding author at: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
    Affiliations
    Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
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Published:September 02, 2022DOI:https://doi.org/10.1016/j.ygyno.2022.08.017

      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

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