Objective: To investigate the surgical indications and perioperative clinical outcomes of pelvic exenteration (PE) for locally advanced, recurrent pelvic malignancies and complex pelvic fistulas. Methods: This was a descriptive study.The indications for performing PE were: (1) locally advanced, recurrent pelvic malignancy or complex pelvic fistula diagnosed preoperatively by imaging and pathological examination of a biopsy; (2)preoperative agreement by a multi-disciplinary team that non-surgical and conventional surgical treatment had failed and PE was required; and (3) findings on intraoperative exploration confirming this conclusion.Contraindications to this surgical procedure comprised cardiac and respiratory dysfunction, poor nutritional status,and mental state too poor to tolerate the procedure.Clinical data of 141 patients who met the above criteria, had undergone PE in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2018 to September 2022, had complete perioperative clinical data, and had given written informed consent to the procedure were collected,and the operation,relevant perioperative variables, postoperative pathological findings (curative resection), and early postoperative complications were analyzed. Results: Of the 141 included patients, 43 (30.5%) had primary malignancies, 61 (43.3%) recurrent malignancies, 28 (19.9%) complex fistulas after radical resection of malignancies,and nine (6.4%)complex fistulas caused by benign disease. There were 79 cases (56.0%) of gastrointestinal tumors, 30 cases (21.3%) of reproductive tumors, 16 cases (11.3%) of urinary tumors, and 7 cases (5.0%) of other tumors such mesenchymal tissue tumors. Among the 104 patients with primary and recurrent malignancies, 15 patients with severe complications of pelvic perineum of advanced tumors were planned to undergo palliative PE surgery for symptom relief after preoperative assessment of multidisciplinary team; the other 89 patients were evaluated for radical PE surgery. All surgeries were successfully completed. Total PE was performed on 73 patients (51.8%),anterior PE on 22 (15.6%),and posterior PE in 46 (32.6%). The median operative time was 576 (453,679) minutes, median intraoperative blood loss 500 (200, 1 200) ml, and median hospital stay 17 (13.0,30.5)days.There were no intraoperative deaths. Of the 89 patients evaluated for radical PE surgery, the radical R0 resection was achieved in 64 (71.9%) of them, R1 resection in 23 (25.8%), and R2 resection in two (2.2%). One or more postoperative complications occurred in 85 cases (60.3%), 32 (22.7%)of which were Clavien-Dindo grade III and above.One patient (0.7%)died during the perioperative period. Conclusion: PE is a valid option for treating locally advanced or recurrent pelvic malignancies and complex pelvic fistulas.
目的： 探讨盆腔脏器联合切除（PE）手术在局部晚期、复发盆腔恶性肿瘤及盆腔复杂瘘治疗中的手术适应证及围手术期临床结局。 方法： 本研究为描述性病例系列研究。PE手术适应证：（1）术前经影像学及病理活检确诊为局部晚期或复发的盆腔恶性肿瘤或确诊盆腔复杂瘘；（2）非手术治疗及常规手术治疗失败、术前经多学科团队讨论以及术中探查，确认需联合切除盆腔脏器；（3）术前经过多学科团队评估可实施PE。手术禁忌证包括心肺等器官功能不全、营养状态或心理状态不佳而无法耐受手术。纳入2018年1月至2022年9月期间，符合上述标准并于中山大学附属第六医院行PE手术、围手术期临床资料完整、获得患者手术知情同意的患者临床资料，分析手术和围手术期情况、术后病理情况（手术根治性）以及术后早期并发症发生情况。 结果： 纳入141例患者，其中43例（30.5%）为原发恶性肿瘤，61例（43.3%）为复发恶性肿瘤，28例（19.9%）为肿瘤根治后复杂瘘，9例（6.4%）为良性病致复杂瘘。其中胃肠道来源肿瘤79例（56.0%），生殖系统来源肿瘤30例（21.3%），泌尿系统来源肿瘤16例（11.3%），间叶组织来源等其他肿瘤7例（5.0%）。本组104例原发和复发恶性肿瘤患者中，15例晚期肿瘤盆会阴严重并发症患者，术前经多学科评估无法根治，计划行姑息性PE手术以缓解症状；其余89例患者经多学科评估可行根治性的PE手术。所有手术均顺利完成。73例（51.8%）行全盆腔脏器联合切除（TPE），22例（15.6%）行前盆腔脏器联合切除（APE），46例（32.6%）行后盆腔脏器联合切除（PPE）。全组中位手术时间576（453，679）min，中位术中出血量500（200，1 200）ml，中位术后住院时间17.0（13.0，30.5）d，无术中死亡病例。89例评估可行根治性PE手术的患者中，64例（71.9%）达到盆腔内肿瘤根治性R0切除，23例（25.8%）R1切除，2例（2.2%）R2切除。术后85例（60.3%）出现一种及以上并发症，32例（22.7%）Clavien-Dindo Ⅲ级以上并发症，1例（0.7%）围手术期死亡。 结论： PE手术是治疗局部晚期、复发盆腔恶性肿瘤及盆腔复杂瘘的一种可选治疗手段，围手术期安全性较好。.