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Prediction of short-term surgical complications in women undergoing pelvic exenteration for gynecological malignancies.

Abstract：

OBJECTIVE:Pelvic exenteration (PE) is an extensive surgery associated with high rates of postoperative morbidity and mortality. The absence of well-defined preoperative selection criteria to identify patients eligible for PE prompted the assessment of pre-operative predictors of 30-day major surgical complications. METHODS:Demographics and surgical characteristics of patients undergoing PE for gynecologic cancer in a single institution between 01/2004-12/2016 were reviewed. Postoperative complications within 30 days following surgery were graded using the Accordion grading system. Logistic regression was used to analyze potential risk factors for severe postoperative complications. RESULTS:A total of 138 patients were included in the cohort. Forty-five patients underwent total PE, 52 anterior PE, and 41 posterior PE. Among the 137 patients with follow-up, a severe postoperative complication was experienced by 37 patients (27.0%) and 3 patients (2.2%) experienced death within 90 days. The most frequent grade 3 complications were complications of urinary reconstruction (n = 15), wound dehiscence (n = 9), and abdominal abscess requiring intervention with drain or return to the operating room (n = 6). On multivariable analysis, independent predictors of severe postoperative complications were anterior or total PE (adjusted odds ratio (aOR): 11.66, 95% CI 2.56-53.18), pre-operative hemoglobin ≤10 mg/dl (aOR 2.70, 95% CI 1.02-7.14) and presence of 3+ comorbidities (aOR: 2.76, 95% CI 1.07-7.10). CONCLUSIONS:Major complications after exenteration are common. Surgical complexity and patient selection play a considerable role in predicting complications. These data can be used to better risk stratify patients undergoing PE.

journal_name

Gynecol Oncol

journal_title

Gynecologic oncology

authors

Tortorella L,Casarin J,Mara KC,Weaver AL,Multinu F,Glaser GE,Cliby WA,Scambia G,Mariani A,Kumar A

doi

10.1016/j.ygyno.2018.10.036

subject

Has Abstract

pub_date

2019-01-01 00:00:00

pages

151-156

issue

eissn

0090-8258

issn

1095-6859

pii

S0090-8258(18)31350-7

journal_volume

152

pub_type

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Prediction of short-term surgical complications in women undergoing pelvic exenteration for gynecological malignancies.