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Minimally invasive surgery techniques in pelvic exenteration: a systematic and meta-analysis review

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Abstract

Background

Pelvic exenteration is potentially curative for locally advanced and recurrent pelvic cancers. Evolving technology has facilitated the use of minimally invasive surgical (MIS) techniques in selected cases. We aimed to compare outcomes between open and MIS pelvic exenteration.

Methods

A review of comparative studies was performed. Firstly, we evaluated the differences in surgical techniques with respect to operative time, blood loss, and margin status. Secondly, we assessed differences in 30-day morbidity and mortality rates, and length of hospital stay.

Results

Four studies that directly compared open and MIS exenteration were included. Analysis was performed on 170 patients; 78.1% (n = 133) had open pelvic exenteration, while 21.8% (n = 37) had a MIS exenteration. The median age for open exenteration was 57.7 years versus 63 years for MIS exenteration. Even though the operative time for MIS exenteration was 83 min longer (p < 0.001), it was associated with a median of 1,750mls less blood loss. The morbidity rate for MIS exenterative group was 56.7% (n = 21/37) versus 88.5% (n = 85/96) in the open exenteration group, with pooled analysis observing a 1.17 relative risk increase in 30-day morbidity (p = 0.172) in the open exenteration group. In addition, the MIS cohort had a 6-day shorter length of hospital stay (p = 0.04).

Conclusion

MIS exenteration can be performed in highly selective cases, where there is favourable patient anatomy and tumour characteristics. When feasible, it is associated with reduced intra-operative blood loss, shorter length of hospital stay, and reduced morbidity.

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PelvEx Collaborative authors

Srinivasaiah N, Shekleton F, Kelly ME, Harji D, Malietzis G, Askari A, Aalbers AGJ, Alberda W, Antoniou A, Austin KK, Beets GL, Berg PL, Beynon J, Bosman SJ, Brunner M, Burger JWA, Campain N, Christensen HK, Coscia M, Colquhoun AJ, Coyne P, Daniels IR, Davies RJ, de Wilt JHW, Denost Q, Deutsch C, Dietz D, Duff M, Eglinton T, Fearnhead N, Frizelle FA, Garcia-Sabrido JL, George ML, Gentilini L, Griffiths B, Harris DA, Evans M, Heriot AG, Hohenberger W, Hoe CM, Holm T, Kanemitsu Y, Chan KKL, Kim H, Koh CE, Kok NF, Kontovounisios C, Law WL, Laurberg S, Lee P, Lydrup ML, Lynch AC, Martling A, Meijerink J, Mentha A, Merkel S, McDermott FD, McGrath JS, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Abraham-Nordling M, O’Connell PR, Patsouras D, Poggioli G, Radwan RW, Rasheed S, Rasmussen PC, Rothbarth J, Rutten HJT, Sagar PM, Schizas AMP, Shida D, Smart NJ, Solomon MJ, Sorensen MM, Stocchi L, Tekkis PP, Tsukamoto S, Turner WH, Tuynman JB, van Ramshorst GH, van Zoggel D, Vasquez-Jimenez W, Verhoef C, Verstegen M, Wakeman C, Warrier S, Yip J, Winter DC, Jenkins JT.

Author information

Authors and Affiliations

    Consortia

    The PelvEx Collaborative

    • N. Srinivasaiah
    • , F. Shekleton
    • , M. E. Kelly
    • , D. Harji
    • , G. Malietzis
    • , A. Askari
    • , A. G. J. Aalbers
    • , W. Alberda
    • , A. Antoniou
    • , K. K. Austin
    • , G. L. Beets
    • , P. L. Berg
    • , J. Beynon
    • , S. J. Bosman
    • , M. Brunner
    • , J. W. A. Burger
    • , N. Campain
    • , H. K. Christensen
    • , M. Coscia
    • , A. J. Colquhoun
    • , P. Coyne
    • , I. R. Daniels
    • , R. J. Davies
    • , J. H. W. de Wilt
    • , Q. Denost
    • , C. Deutsch
    • , D. Dietz
    • , M. Duff
    • , T. Eglinton
    • , N. Fearnhead
    • , F. A. Frizelle
    • , J. L. Garcia-Sabrido
    • , M. L. George
    • , L. Gentilini
    • , B. Griffiths
    • , D. A. Harris
    • , M. Evans
    • , A. G. Heriot
    • , W. Hohenberger
    • , C. M. Hoe
    • , T. Holm
    • , Y. Kanemitsu
    • , K. K. L. Chan
    • , H. Kim
    • , C. E. Koh
    • , N. F. Kok
    • , C. Kontovounisios
    • , W. L. Law
    • , S. Laurberg
    • , P. Lee
    • , M. L. Lydrup
    • , A. C. Lynch
    • , A. Martling
    • , J. Meijerink
    • , A. Mentha
    • , S. Merkel
    • , F. D. McDermott
    • , J. S. McGrath
    • , M. B. Nielsen
    • , G. A. P. Nieuwenhuijzen
    • , P. J. Nilsson
    • , M. Abraham-Nordling
    • , P. R. O’Connell
    • , D. Patsouras
    • , G. Poggioli
    • , R. W. Radwan
    • , S. Rasheed
    • , P. C. Rasmussen
    • , J. Rothbarth
    • , H. J. T. Rutten
    • , P. M. Sagar
    • , A. M. P. Schizas
    • , D. Shida
    • , N. J. Smart
    • , M. J. Solomon
    • , M. M. Sorensen
    • , L. Stocchi
    • , P. P. Tekkis
    • , S. Tsukamoto
    • , W. H. Turner
    • , J. B. Tuynman
    • , G. H. van Ramshorst
    • , D. van Zoggel
    • , W. Vasquez-Jimenez
    • , C. Verhoef
    • , M. Verstegen
    • , C. Wakeman
    • , S. Warrier
    • , J. Yip
    • , D. C. Winter
    •  & J. T. Jenkins

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    Conflict of interest

    All PelvEx Collaborative authors declare no conflict of interest.

    Additional information

    PelvEx Collaborative—JT Jenkins, St Mark’s Hospital, London, email: mrianjenkins@icloud.com.

    All PelvEx Collaborative members are co-authors and approved this submission. The list of authors is provided at the end of the article.

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    Cite this article

    The PelvEx Collaborative. Minimally invasive surgery techniques in pelvic exenteration: a systematic and meta-analysis review. Surg Endosc 32, 4707–4715 (2018). https://doi.org/10.1007/s00464-018-6299-5

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    • DOI: https://doi.org/10.1007/s00464-018-6299-5

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