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Article: Palliative pelvic exenteration: A systematic review of patient-centered outcomes

TitlePalliative pelvic exenteration: A systematic review of patient-centered outcomes
Authors
Kroon, HMDudi-Venkata, NNBedrikovetski, SThomas, MLKelly, MEAalbers, AGJAbdul Aziz, NAbraham-Nordling, MAkiyoshi, TAlberda, WAndric, MFearnhead, NSFrizelle, FAGarcia-Granero, EGarcia-Sabrido, JLGentilini, LGeorge, MLGlynn, RGolda, TGriffiths, BHarris, DAPatsouras, DEvans, MHagemans, JAWHarji, DPHeriot, AGHohenberger, WHolm, TJenkins, JTKapur, SKanemitsu, YKelley, SRPellino, GKeller, DSKim, HKoh, CEKok, NFMKokelaar, RKontovounisios, CKusters, MLarson, DWLaw, WLLaurberg, SPoggioli, GLee, PLydrup, MLLynch, ACMantyh, CMathis, KLMartling, AMeijerink, WJHJMerkel, SMehta, AMMcDermott, FDQuinn, MMcGrath, JSMirnezami, AMorton, JRMullaney, TGMesquita-Neto, JWNielsen, MBNieuwenhuijzen, GAPNilsson, PJO'Connell, PRPalmer, GQuyn, ARadwan, RWRasheed, SRasmussen, PCRegenbogen, SERocha, RAntoniou, ARothbarth, JRoxburgh, CRutten, HJTRyan, ÉSagar, PMSaklani, ASchizas, AMPSchwarzkopf, EScripcariu, VShaikh, IAustin, KKShida, DSimpson, ASmart, NJSmith, JJSolomon, MJSørensen, MMSteele, SRSteffens, DStocchi, LStylianides, NABaker, RPTekkis, PPTaylor, CTsarkov, PTsukamoto, STurner, WHTuynman, JBvan Ramshorst, GHvan Zoggel, DVasquez-Jimenez, WVerhoef, CBali, MVerstegen, MWakeman, CWarrier, SWasmuth, HHWeiser, MRWheeler, JMDWild, JYip, JWinter, DCSammour, TBaseckas, GBednarski, BKBeets, GLBerg, PLBeynon, JBiondo, SBordeianou, LBrunner, MBuchwald, PBurger, JWABurling, DCampain, NChan, KKLChang, GJChew, MHC Chong, PChristensen, HKCodd, MColquhoun, AJCorr, ACoscia, MCoyne, PECreavin, BDamjanovic, LDaniels, IRDavies, MDavies, RJde Wilt, JHWDenost, QDietz, DDozois, EJDuff, MEglinton, TEnriquez-Navascues, JMEvans, MD
KeywordsPelvic exenteration
Palliative surgery
Locally advanced pelvic cancer
Palliative care
Issue Date2019
PublisherWB Saunders Co Ltd. The Journal's web site is located at http://www.elsevier.com/locate/ejso
Citation
European Journal of Surgical Oncology, 2019, v. 45 n. 10, p. 1787-1795 How to Cite?
AbstractObjective: Palliative pelvic exenteration (PPE) is a technically complex operation with high morbidity and mortality rates, considered in patients with limited life expectancy. There is little evidence to guide practice. We performed a systematic review to evaluate the impact of PPE on symptom relief and quality of life (QoL). Methods: A systematic review was conducted according to the PRISMA guidelines using Ovid MEDLINE, EMBASe, and PubMed databases for studies reporting on outcomes of PPE for symptom relief or QoL. Descriptive statistics were used on pooled patient cohorts. Results: Twenty-three historical cohorts and case series were included, comprising 509 patients. No comparative studies were found. Most malignancies were of colorectal, gynaecological and urological origin. Common indications for PPE were pain, symptomatic fistula, bleeding, malodour, obstruction and pelvic sepsis. The pooled median postoperative morbidity rate was 53.6% (13–100%), the median in-hospital mortality was 6.3% (0–66.7%), and median OS was 14 months (4–40 months). Some symptom relief was reported in a median of 79% (50–100%) of the patients, although the magnitude of effect was poorly measured. Data for QoL measures were inconclusive. Five studies discouraged performing PPE in any patient, while 18 studies concluded that the procedure can be considered in highly selected patients. Conclusion: Available evidence on PPE is of low-quality. Morbidity and mortality rates are high with a short median OS interval. While some symptom relief may be afforded by this procedure, evidence for improvement in QoL is limited. A highly selective individualised approach is required to optimise the risk:benefit equation.
DescriptionThe PelvEx Collaborative
Persistent Identifierhttp://hdl.handle.net/10722/293453
ISSN
2020 Impact Factor: 4.424
2020 SCImago Journal Rankings: 1.395
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorKroon, HM-
dc.contributor.authorDudi-Venkata, NN-
dc.contributor.authorBedrikovetski, S-
dc.contributor.authorThomas, ML-
dc.contributor.authorKelly, ME-
dc.contributor.authorAalbers, AGJ-
dc.contributor.authorAbdul Aziz, N-
dc.contributor.authorAbraham-Nordling, M-
dc.contributor.authorAkiyoshi, T-
dc.contributor.authorAlberda, W-
dc.contributor.authorAndric, M-
dc.contributor.authorFearnhead, NS-
dc.contributor.authorFrizelle, FA-
dc.contributor.authorGarcia-Granero, E-
dc.contributor.authorGarcia-Sabrido, JL-
dc.contributor.authorGentilini, L-
dc.contributor.authorGeorge, ML-
dc.contributor.authorGlynn, R-
dc.contributor.authorGolda, T-
dc.contributor.authorGriffiths, B-
dc.contributor.authorHarris, DA-
dc.contributor.authorPatsouras, D-
dc.contributor.authorEvans, M-
dc.contributor.authorHagemans, JAW-
dc.contributor.authorHarji, DP-
dc.contributor.authorHeriot, AG-
dc.contributor.authorHohenberger, W-
dc.contributor.authorHolm, T-
dc.contributor.authorJenkins, JT-
dc.contributor.authorKapur, S-
dc.contributor.authorKanemitsu, Y-
dc.contributor.authorKelley, SR-
dc.contributor.authorPellino, G-
dc.contributor.authorKeller, DS-
dc.contributor.authorKim, H-
dc.contributor.authorKoh, CE-
dc.contributor.authorKok, NFM-
dc.contributor.authorKokelaar, R-
dc.contributor.authorKontovounisios, C-
dc.contributor.authorKusters, M-
dc.contributor.authorLarson, DW-
dc.contributor.authorLaw, WL-
dc.contributor.authorLaurberg, S-
dc.contributor.authorPoggioli, G-
dc.contributor.authorLee, P-
dc.contributor.authorLydrup, ML-
dc.contributor.authorLynch, AC-
dc.contributor.authorMantyh, C-
dc.contributor.authorMathis, KL-
dc.contributor.authorMartling, A-
dc.contributor.authorMeijerink, WJHJ-
dc.contributor.authorMerkel, S-
dc.contributor.authorMehta, AM-
dc.contributor.authorMcDermott, FD-
dc.contributor.authorQuinn, M-
dc.contributor.authorMcGrath, JS-
dc.contributor.authorMirnezami, A-
dc.contributor.authorMorton, JR-
dc.contributor.authorMullaney, TG-
dc.contributor.authorMesquita-Neto, JW-
dc.contributor.authorNielsen, MB-
dc.contributor.authorNieuwenhuijzen, GAP-
dc.contributor.authorNilsson, PJ-
dc.contributor.authorO'Connell, PR-
dc.contributor.authorPalmer, G-
dc.contributor.authorQuyn, A-
dc.contributor.authorRadwan, RW-
dc.contributor.authorRasheed, S-
dc.contributor.authorRasmussen, PC-
dc.contributor.authorRegenbogen, SE-
dc.contributor.authorRocha, R-
dc.contributor.authorAntoniou, A-
dc.contributor.authorRothbarth, J-
dc.contributor.authorRoxburgh, C-
dc.contributor.authorRutten, HJT-
dc.contributor.authorRyan, É-
dc.contributor.authorSagar, PM-
dc.contributor.authorSaklani, A-
dc.contributor.authorSchizas, AMP-
dc.contributor.authorSchwarzkopf, E-
dc.contributor.authorScripcariu, V-
dc.contributor.authorShaikh, I-
dc.contributor.authorAustin, KK-
dc.contributor.authorShida, D-
dc.contributor.authorSimpson, A-
dc.contributor.authorSmart, NJ-
dc.contributor.authorSmith, JJ-
dc.contributor.authorSolomon, MJ-
dc.contributor.authorSørensen, MM-
dc.contributor.authorSteele, SR-
dc.contributor.authorSteffens, D-
dc.contributor.authorStocchi, L-
dc.contributor.authorStylianides, NA-
dc.contributor.authorBaker, RP-
dc.contributor.authorTekkis, PP-
dc.contributor.authorTaylor, C-
dc.contributor.authorTsarkov, P-
dc.contributor.authorTsukamoto, S-
dc.contributor.authorTurner, WH-
dc.contributor.authorTuynman, JB-
dc.contributor.authorvan Ramshorst, GH-
dc.contributor.authorvan Zoggel, D-
dc.contributor.authorVasquez-Jimenez, W-
dc.contributor.authorVerhoef, C-
dc.contributor.authorBali, M-
dc.contributor.authorVerstegen, M-
dc.contributor.authorWakeman, C-
dc.contributor.authorWarrier, S-
dc.contributor.authorWasmuth, HH-
dc.contributor.authorWeiser, MR-
dc.contributor.authorWheeler, JMD-
dc.contributor.authorWild, J-
dc.contributor.authorYip, J-
dc.contributor.authorWinter, DC-
dc.contributor.authorSammour, T-
dc.contributor.authorBaseckas, G-
dc.contributor.authorBednarski, BK-
dc.contributor.authorBeets, GL-
dc.contributor.authorBerg, PL-
dc.contributor.authorBeynon, J-
dc.contributor.authorBiondo, S-
dc.contributor.authorBordeianou, L-
dc.contributor.authorBrunner, M-
dc.contributor.authorBuchwald, P-
dc.contributor.authorBurger, JWA-
dc.contributor.authorBurling, D-
dc.contributor.authorCampain, N-
dc.contributor.authorChan, KKL-
dc.contributor.authorChang, GJ-
dc.contributor.authorChew, MH-
dc.contributor.authorC Chong, P-
dc.contributor.authorChristensen, HK-
dc.contributor.authorCodd, M-
dc.contributor.authorColquhoun, AJ-
dc.contributor.authorCorr, A-
dc.contributor.authorCoscia, M-
dc.contributor.authorCoyne, PE-
dc.contributor.authorCreavin, B-
dc.contributor.authorDamjanovic, L-
dc.contributor.authorDaniels, IR-
dc.contributor.authorDavies, M-
dc.contributor.authorDavies, RJ-
dc.contributor.authorde Wilt, JHW-
dc.contributor.authorDenost, Q-
dc.contributor.authorDietz, D-
dc.contributor.authorDozois, EJ-
dc.contributor.authorDuff, M-
dc.contributor.authorEglinton, T-
dc.contributor.authorEnriquez-Navascues, JM-
dc.contributor.authorEvans, MD-
dc.date.accessioned2020-11-23T08:16:59Z-
dc.date.available2020-11-23T08:16:59Z-
dc.date.issued2019-
dc.identifier.citationEuropean Journal of Surgical Oncology, 2019, v. 45 n. 10, p. 1787-1795-
dc.identifier.issn0748-7983-
dc.identifier.urihttp://hdl.handle.net/10722/293453-
dc.descriptionThe PelvEx Collaborative-
dc.description.abstractObjective: Palliative pelvic exenteration (PPE) is a technically complex operation with high morbidity and mortality rates, considered in patients with limited life expectancy. There is little evidence to guide practice. We performed a systematic review to evaluate the impact of PPE on symptom relief and quality of life (QoL). Methods: A systematic review was conducted according to the PRISMA guidelines using Ovid MEDLINE, EMBASe, and PubMed databases for studies reporting on outcomes of PPE for symptom relief or QoL. Descriptive statistics were used on pooled patient cohorts. Results: Twenty-three historical cohorts and case series were included, comprising 509 patients. No comparative studies were found. Most malignancies were of colorectal, gynaecological and urological origin. Common indications for PPE were pain, symptomatic fistula, bleeding, malodour, obstruction and pelvic sepsis. The pooled median postoperative morbidity rate was 53.6% (13–100%), the median in-hospital mortality was 6.3% (0–66.7%), and median OS was 14 months (4–40 months). Some symptom relief was reported in a median of 79% (50–100%) of the patients, although the magnitude of effect was poorly measured. Data for QoL measures were inconclusive. Five studies discouraged performing PPE in any patient, while 18 studies concluded that the procedure can be considered in highly selected patients. Conclusion: Available evidence on PPE is of low-quality. Morbidity and mortality rates are high with a short median OS interval. While some symptom relief may be afforded by this procedure, evidence for improvement in QoL is limited. A highly selective individualised approach is required to optimise the risk:benefit equation.-
dc.languageeng-
dc.publisherWB Saunders Co Ltd. The Journal's web site is located at http://www.elsevier.com/locate/ejso-
dc.relation.ispartofEuropean Journal of Surgical Oncology-
dc.subjectPelvic exenteration-
dc.subjectPalliative surgery-
dc.subjectLocally advanced pelvic cancer-
dc.subjectPalliative care-
dc.titlePalliative pelvic exenteration: A systematic review of patient-centered outcomes-
dc.typeArticle-
dc.identifier.emailChan, KKL: kklchan@hkucc.hku.hk-
dc.identifier.authorityChan, KKL=rp00499-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.ejso.2019.06.011-
dc.identifier.pmid31255441-
dc.identifier.scopuseid_2-s2.0-85067877729-
dc.identifier.hkuros319729-
dc.identifier.volume45-
dc.identifier.issue10-
dc.identifier.spage1787-
dc.identifier.epage1795-
dc.identifier.isiWOS:000491301600006-
dc.publisher.placeUnited Kingdom-
dc.identifier.issnl0748-7983-

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