Abstract
Introduction
Pelvic exenteration (PE) is a complex multivisceral surgical procedure indicated for
locally advanced or recurrent pelvic malignancies. It poses significant technical
challenges which account for the high risk of morbidity and mortality associated with
the procedure. Developments in minimally invasive surgical (MIS) approaches and enhanced
peri-operative care have facilitated improved long term outcomes. However, the optimum
approach to PE remains controversial.
Methods
A systematic literature search was conducted in accordance with PRISMA guidelines
to identify studies comparing MIS (robotic or laparoscopic) approaches for PE versus
the open approach for patients with locally advanced or recurrent pelvic malignancies.
The methodological quality of the included studies was assessed systematically and
a meta-analysis was conducted.
Results
11 studies were identified, including 2009 patients, of whom 264 (13.1%) underwent
MIS PE approaches. The MIS group displayed comparable R0 resections (Risk Ratio [RR]
1.02, 95% Confidence Interval [95% CI] 0.98, 1.07, p = 0.35)) and Lymph node yield
(Weighted Mean Difference [WMD] 1.42, 95% CI -0.58, 3.43, p = 0.16), and although
MIS had a trend towards improved towards improved survival and recurrence outcomes,
this did not reach statistical significance. MIS was associated with prolonged operating
times (WMD 67.93, 95% CI 4.43, 131.42, p < 0.00001) however, this correlated with
less intra-operative blood loss, and a shorter length of post-operative stay (WMD
-3.89, 955 CI -6.53, −1.25, p < 0.00001). Readmission rates were higher with MIS (RR
2.11, 95% CI 1.11, 4.02, p = 0.02), however, rates of pelvic abscess/sepsis were decreased
(RR 0.45, 95% CI 0.21, 0.95, p = 0.04), and there was no difference in overall, major,
or specific morbidity and mortality.
Conclusion
MIS approaches are a safe and feasible option for PE, with no differences in survival
or recurrence outcomes compared to the open approach. MIS also reduced the length
of post-operative stay and decreased blood loss, offset by increased operating time.
Keywords
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Article info
Publication history
Published online: April 15, 2023
Accepted:
April 5,
2023
Received in revised form:
March 30,
2023
Received:
March 9,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
