ABSTRACT
BACKGROUND: Our aim in the present study was to evaluate surgical outcomes and complications of pelvic exenteration in the treatment of gynecologic malignancy and to compare surgery-related complications associated with different types of exenteration. METHODS: We performed a retrospective analysis of patients who underwent pelvic exenteration for the treatment of gynecologic cancer between January 2008 and August 2011. Patients were divided into two groups for comparison: total pelvic exenteration (TPE) and nontotal pelvic exenteration (NTE, including anterior pelvic exenteration (APE) posterior pelvic exenteration (PPE)). Outcomes are reported according to the modified Clavien-Dindo Classification of Surgical Complications. RESULTS: Twenty-eight patients were included in the analysis. Eighteen had cervical cancer (64.3%). The prevalence of stage IIIB cervical cancer was 55%. Primary treatment with radiotherapy was performed in 53.3% of patients. Fifty percent of patients underwent TPE, 25% had APE and 25% underwent PPE. Patients who underwent TPE had worse outcomes, with a mean operative time of 367 minutes, use of blood transfusion in 93% of patients, ICU stay of 4.3 days and total hospital stay of 9.4 days. The overall mortality rate was 14.3%, and the surgical site infection rate was 25%. In the TPE group, 78.6% of patients experienced surgical complications. One-fourth of the total patient sample required reoperation, and the leading cause was urinary fistula (57.1%). Urinary leakage occurred in 22.7% of urinary reconstruction patients. Wet colostomy was the most common form of reconstruction with 10% of leakage. CONCLUSIONS: Postoperative urinary and infectious complications accounted for 75% of all causes of morbidity and mortality after pelvic exenteration. TPE is a more complex and morbid procedure than NTE.
Subject(s)
Genital Neoplasms, Female/surgery , Pelvic Exenteration/adverse effects , Postoperative Complications , Urinary Tract Infections/etiology , Adult , Aged , Female , Follow-Up Studies , Genital Neoplasms, Female/complications , Genital Neoplasms, Female/pathology , Humans , Middle Aged , Neoplasm Staging , Prognosis , Retrospective StudiesABSTRACT
O tratamento conservador do câncer inicial da mama, com base na setorectomia com linfadenectomia, associadas ao tratamento adjuvante pós-operatório, tem por finalidade a conservaçäo do parênquima mamário, com o objetivo de manter o aspecto estético, muitas vezes se dispondo de técnicas de reconstruçäo e mamoplastia contralateral. A partir desse fato, os autores apresentam análise retrospectiva de 89 pacientes submetidas ao tratamento conservador, no período de janeiro de 1987 a dezembro de 1995, relacionando seus índices de sobrevida global (74,15 por cento), sobrevida livre de doença em 5 anos (64 por cento) e mortalidade por câncer (19 por cento) às modalidades terapêuticas utilizadas. Com os resultados obtidos, os autores comparam sua experiência aos dados da literatura
