Background/Objectives: Pelvic exenteration is a complex surgery considered for locally advanced or recurrent pelvic malignancies, entailing a radical en-block resection of multiple adjacent pelvic organs, followed by reconstructive surgery. Achieving R0 resection (complete removal of macroscopic and microscopic disease) is critical for improving survival outcomes. This study aimed to define patient, tumour, and surgical predictors of R0 resection in an irradiated field, thereby optimising patient selection and establishing a surgical roadmap for pelvic exenterations. Methods: Our retrospective observational cohort study includes consecutive patients undergoing exenteration post-radiotherapy for non-ovarian gynaecological malignancies at Oxford University Hospitals between 1 January 2011 and 31 December 2024. The primary outcome was margin status. Secondary outcomes were intraoperative and postoperative complications. Results: Twenty-seven patients were identified, with a median age of 63 years (range 41–81) and median BMI of 27 (range 17–45). Primary tumour sites included the vulva (11.1%), vagina (14.8%), cervix (40.7%), and uterus (33.3%). R0 was achieved in 77.8% (n = 21) of cases. Intraoperative complications occurred in 29.6%, and significant postoperative complications (Clavien-Dindo IIIA/IIIB) in 22.2% of patients. R0 resection was significantly associated with younger age (median 61 vs. 70 years,p= 0.035) and primary cervical tumours (p= 0.036). On univariable logistic regression, tumour size on imaging (p= 0.038, OR 2.9) and on histology (p= 0.020, OR 2.01), and estimated blood loss (p= 0.048, OR 1.002) were significant predictors of R0 resection. None of these variables retained significance in multivariable logistic regression. Conclusions: Tumour size, primary tumour site, and patient age should be considered when selecting patients for pelvic exenteration following radiotherapy, and blood loss should be kept minimal in order to maximise the chances of achieving R0 resection.
背景/目的：盆腔廓清术是针对局部晚期或复发性盆腔恶性肿瘤的复杂手术，需对多个相邻盆腔器官进行整块根治性切除，随后进行重建手术。实现R0切除（宏观与微观病灶的完全清除）对改善患者生存结局至关重要。本研究旨在明确放疗后盆腔廓清术中影响R0切除的患者、肿瘤及手术相关预测因素，从而优化患者选择并建立手术路径规划。方法：本回顾性观察性队列研究纳入2011年1月1日至2024年12月31日期间在牛津大学医院接受放疗后盆腔廓清术的非卵巢妇科恶性肿瘤连续病例。主要观察指标为切缘状态，次要观察指标为术中及术后并发症。结果：共纳入27例患者，中位年龄63岁（范围41-81岁），中位体重指数27（范围17-45）。原发肿瘤部位包括外阴（11.1%）、阴道（14.8%）、宫颈（40.7%）和子宫（33.3%）。77.8%（n=21）的病例实现R0切除。术中并发症发生率为29.6%，严重术后并发症（Clavien-Dindo IIIA/IIIB级）发生率为22.2%。R0切除与较低年龄（中位61岁 vs 70岁，p=0.035）及宫颈原发肿瘤（p=0.036）显著相关。单变量逻辑回归分析显示，影像学肿瘤大小（p=0.038，OR 2.9）、组织学肿瘤大小（p=0.020，OR 2.01）及预估失血量（p=0.048，OR 1.002）是R0切除的显著预测因素，但这些变量在多变量逻辑回归中均未保持显著性。结论：在选择放疗后盆腔廓清术患者时，应综合考虑肿瘤大小、原发部位及患者年龄，并尽可能减少术中失血，以最大限度提高实现R0切除的可能性。
肿瘤(癌症)患者之家