Universität zu Köln

Lampe, Bjoern., Luengas-Wuerzinger, Veronica, Weitz, Juergen, Roth, Stephan, Rawert, Friederike ORCID: 0000-0002-7679-1190, Schuler, Esther, Classen-von Spee, Sabrina, Fix, Nando, Baransi, Saher ORCID: 0000-0002-5144-7481, Dizdar, Anca, Mallmann, Peter, Schaser, Klaus-Dieter and Bogner, Andreas ORCID: 0000-0001-9226-5337 (2021). Opportunities and Limitations of Pelvic Exenteration Surgery. Cancers, 13 (24). BASEL: MDPI. ISSN 2072-6694

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Abstract

Simple Summary Pelvic exenteration is often the only curative treatment option for selected locally advanced tumours, and especially for recurrent cancers. Because of the heterogeneous patient population with different clinical pictures, it is not possible to standardize the indication, treatment strategy and surgical technique for this procedure. For the same reason, as well as a rather low annual number of total cases, clinical trials are notably difficult to design. However, it is important to underline the often-underestimated possibilities of surgical treatment when a R0 resection is achievable, with a low mortality and acceptable postoperative quality of life. Purpose: The practice of exenterative surgery is sometimes controversial and has garnered a certain scepticism. Surgical studies are difficult to conduct due to insufficient data. The aim of this review is to present the current standing of pelvic exenteration from a surgical, gynaecological and urological point of view. Methods: This review is based upon a literature review (MEDLINE (PubMed), CENTRAL (Cochrane) and EMBASE (Elsevier)) of retrospective studies on exenterative surgery from 1993-2020. Using MeSH (Medical Subject Headings) search terms, 1572 publications were found. These were evaluated and screened with respect to their eligibility using algorithms and well-defined inclusion and exclusion criteria. Therefore, the guidelines for systematic reviews (PRISMA) were used. Results: A complete tumour resection (R0) often represents the only curative option for advanced pelvic carcinomas and their recurrences. A recent systematic review showed significant symptom relief in 80% of palliative patients after pelvic exenteration. Surgical limitations (distant metastases, involvement of the pelvic wall, etc.) are diminished by adequate surgical expertise and close interdisciplinary cooperation. While the mortality rate is low (2-5%), the still relatively high morbidity rate (32-84%) can be minimized by optimizing the perioperative setting. Following exenterations, roughly 79-82% of patients report satisfying results according to PROs (patient-reported outcomes). Conclusion: Due to multimodality treatment strategies combined with extended surgical expertise and patients' preferences, pelvic exenteration can be offered nowadays with low mortality and acceptable postoperative quality of life. The possibilities of surgical treatment are often underestimated. A multi-centre database (PelvEx Collaborative) was established to collect data and experiences to optimize the research in this field.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Lampe, Bjoern. UNSPECIFIED UNSPECIFIED UNSPECIFIED Luengas-Wuerzinger, Veronica UNSPECIFIED UNSPECIFIED UNSPECIFIED Weitz, Juergen UNSPECIFIED UNSPECIFIED UNSPECIFIED Roth, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Rawert, Friederike UNSPECIFIED orcid.org/0000-0002-7679-1190 UNSPECIFIED Schuler, Esther UNSPECIFIED UNSPECIFIED UNSPECIFIED Classen-von Spee, Sabrina UNSPECIFIED UNSPECIFIED UNSPECIFIED Fix, Nando UNSPECIFIED UNSPECIFIED UNSPECIFIED Baransi, Saher UNSPECIFIED orcid.org/0000-0002-5144-7481 UNSPECIFIED Dizdar, Anca UNSPECIFIED UNSPECIFIED UNSPECIFIED Mallmann, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Schaser, Klaus-Dieter UNSPECIFIED UNSPECIFIED UNSPECIFIED Bogner, Andreas UNSPECIFIED orcid.org/0000-0001-9226-5337 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-582186
DOI:	10.3390/cancers13246162
Journal or Publication Title:	Cancers
Volume:	13
Number:	24
Date:	2021
Publisher:	MDPI
Place of Publication:	BASEL
ISSN:	2072-6694
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language RECURRENT CERVICAL-CANCER; SURGICAL-TREATMENT; URINARY-DIVERSION; J-POUCH; RESECTION; OUTCOMES; EXPERIENCE; MANAGEMENT; MORBIDITY; SURVIVAL Multiple languages Oncology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/58218