预测妇科恶性肿瘤盆腔根治术后手术并发症的相关因素：一家大型单机构经验。
Predictive factors of surgical complications after pelvic exenteration for gynecological malignancies: a large single-institution experience.
发表日期：2023 Sep 11
作者：
Lucia Tortorella, Cintoni Marco, Matteo Loverro, Conte Carmine, Eleonora Persichetti, Nicolò Bizzarri, Costantini Barbara, Santullo Francesco, Nazario Foschi, Valerio Gallotta, Giacomo Avesani, Vito Chiantera, Alfredo Ercoli, Francesco Fanfani, Anna Fagotti, Maria Cristina Mele, Stefano Restaino, Salvatore Gueli Alletti, Giovanni Scambia, Giuseppe Vizzielli
来源：
DIABETES & METABOLISM
摘要：
为了评估妇科恶性肿瘤患者在盆腔切除术（PE）术前30天内发生严重并发症（Dindo 3+级）的预测因素，我们对2010年至2019年期间在Fondazione Policlinico Gemelli接受手术的129名患者进行了回顾性分析。我们纳入了患有原发或复发/持续性的宫颈、子宫内膜或阴茎/阴道癌的患者。根据Dindo分类法对术后并发症进行了分级。采用Logistic回归分析潜在的并发症预测因素。我们进行了63例前置PE，10例后置PE和56例全PE。早期严重术后并发症的发生率为27.9％（n=36），早期死亡率为2.3％（n=3）。较常见的并发症与尿路引流和肠道手术有关。在单变量分析中，血红蛋白≤10 g/dL（危险比[OR]=4.2；95％置信区间[CI]=1.65-10.7；p=0.003）、低白蛋白水平（OR=3.9；95％CI=1.27-12.11；p=0.025）、糖尿病（OR=4.15；95％CI=1.22-14.1；p=0.022）以及2个及以上的并存疾病（OR=5.18；95％CI=1.49-17.93；p=0.012）是早期严重并发症的预测因素。在多元分析中，只有血红蛋白水平低和术前并存疾病是并发症的独立预测因子。盆腔切除术是一种具有高发术后并发症率的激进手术。术前评估患者的并存疾病和健康状况对于更好地选择适合此类手术的合适候选者至关重要。© 2024. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology.
To evaluate pre-operative predictors of early (<30 days) severe complications (grade Dindo 3+) in patients with gynecological malignancy submitted to pelvic exenteration (PE).We retrospectively analyzed 129 patients submitted to surgery at Fondazione Policlinico Gemelli between 2010 and 2019. We included patients affected by primary or recurrent/persistent cervical, endometrial, or vulvar/vaginal cancers. Post-operative complications were graded according to the Dindo classification. Logistic regression was used to analyze potential predictors of complications.We performed 63 anterior PE, 10 posterior PE, and 56 total PE. The incidence of early severe post-operative complications was 27.9% (n=36), and the early mortality rate was 2.3% (n=3). More frequent complications were related to the urinary diversion and intestinal surgery. In univariable analysis, hemoglobin ≤10 g/dL (odds ratio [OR]=4.2; 95% confidence interval [CI]=1.65-10.7; p=0.003), low albumin levels (OR=3.9; 95% CI=1.27-12.11; p=0.025), diabetes (OR=4.15; 95% CI=1.22-14.1; p=0.022), 2+ comorbidities at presentation (OR=5.18; 95% CI=1.49-17.93; p=0.012) were predictors of early severe complications. In multivariable analysis, only low hemoglobin and comorbidities at presentation were independent predictors of complications.Pelvic exenteration is an aggressive surgery characterized by a high rate of post-operative complications. Pre-operative assessment of comorbidities and patient health status are crucial to better select the right candidate for this type of surgery.© 2024. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology.