Abstract 47P
Background
While traditional pelvic exenterations (PE) represent a potentially curative treatment for recurrent tumours localized centrally in the pelvis, new surgical techniques have been developed recently to enable a complete resection even in tumours invading into the pelvic side wall. Extended pelvic exenterations (EPE) include resection of internal, external, or common iliac vessels, pelvic side-wall muscles, large pelvic nerves, or pelvic bones. EPE are currently performed only in a few institutions and data on treatment morbidity are not available. The aim of the study was to compare health-related quality of life (QoL) and oncological outcome after PE and EPE.
Methods
Data from 72 patients with cervical (36), vulvar (19), endometrial (14) and low-grade ovarian (5) cancer who underwent PE (42) or EPE (32) for persistent (20%) or recurrent (80%) disease between 2014 to 2019 at a single tertiary centre were analysed. Quality of life was evaluated in surviving patients using EORTC QLQ-C30, EORTC CX-24, and QOLPEX questionnaire developed specifically for patients after extensive pelvic procedures.
Results
Median overall and disease-specific survival reached in the whole cohort 45 and 49 months, without significant differences between PE and EPE groups (P >0.999). We did not observe any difference in post-surgical complication types or frequency between the groups. Thirty-one survivors participated in the QoL assessment (20 PE, 11 EPE) and no significant differences were found in global health status (P=0.951) or in any of the functional scales. The groups were not differing in therapy satisfaction (P=0.502), and both expressed similar willingness to potentially undergo treatment again (P=0.317) (Table). Table: 47P
EORTC QLQ 30, EORTC QLQ-CX24 – Main results
| Pelvic exenteration | Extended pelvic exenteration | ||||
| Valid (missing) | Mean (SD) | Valid (missing) | Mean (SD) | P-value | |
| Functional scales (higher value = better functioning) | |||||
| Global health status | 20 | 62.9 (19.75) | 11 | 64.5 (21.36) | 0.951 |
| Physical functioning | 20 | 67.2 (23.92) | 11 | 73.0 (19.62) | 0.583 |
| Role functioning | 20 | 57.8 (40.28) | 11 | 60.9 (31.84) | 0.951 |
| Emotional functioning | 20 | 75.2 (20.64) | 11 | 81.2 (18.34) | 0.427 |
| Cognitive functioning | 20 | 87.8 (16.78) | 11 | 82.3 (11.60) | 0.157 |
| Therapy assessment (higher value = higher satisfaction) | |||||
| Would undergo again | 20 | 83.8 (28.42) | 11 | 72.7 (28.40) | 0.317 |
| Therapy satisfaction | 20 | 90.0 (18.85) | 11 | 86.36 (17.19) | 0.502 |
SD, standard deviation.
Conclusions
EPE are associated with similar post-treatment QoL and survival as traditional PE. These procedures represent potentially curative treatment option for patients with persistent or recurrent pelvic cancer invading into pelvic wall structures without further compromising QoL.
Legal entity responsible for the study
The authors.
Funding
Charles University in Prague (UNCE 204065 and PROGRES Q28/LF1).
Disclosure
All authors have declared no conflicts of interest.