PMID- 30792003
OWN - NLM
STAT- Publisher
LR  - 20190329
IS  - 1095-6859 (Electronic)
IS  - 0090-8258 (Linking)
DP  - 2019 Feb 19
TI  - Performance and outcome of pelvic exenteration for gynecologic malignancies: A
      population-based study.
LID - S0090-8258(19)30105-2 [pii]
LID - 10.1016/j.ygyno.2019.02.002 [doi]
AB  - OBJECTIVE: To examine changes in performance and outcomes of pelvic exenteration 
      for gynecologic malignancies. METHODS: This is a population-based retrospective
      study examining the Nationwide Inpatient Sample between 2001 and 2015. Women with
      cervical, uterine, vaginal, and vulvar malignancies who underwent pelvic
      exenteration were examined. Comorbidity, perioperative complications, total
      charges, length of stay, and mortality were assessed. RESULTS: There were 2647
      cases included. Cervical cancer was the most common malignancy (45.1%), followed 
      by vaginal cancer (27.6%). 26.9% of women had a Charlson Comorbidity Index >/=3, 
      which significantly increased from 23.3% in 2001-2005 to 33.3% in 2011-2015
      (42.9% relative increase, P<0.001). Obese women undergoing exenteration increased
      significantly from 4.5% in 2001-2005 to 19.4% in 2011-2015 (3.3-fold relative
      increase, P<0.001). The perioperative complication rate was 68.1%, including
      38.7% with multiple complications. The mortality rate was 1.9%. The number of
      women with multiple perioperative complications increased from 29.4% in 2001-2005
      to 52.8% in 2011-2015 (78.6% relative increase, P<0.001). More recent year of
      surgery, obesity, higher comorbidity, higher household income, surgery at large
      bedsize hospital, urinary diversion, vaginal reconstruction, and vulvar cancer
      were associated with an increased risk of multiple complications on multivariable
      analysis (all, P<0.05). Median length of stay was 14 (IQR 9-21) days, and the
      number of women hospitalized >/=28days significantly increased from 12.6% in
      2001-2005 to 19.1% in 2011-2015 (51.6% relative increase, P<0.001). The median
      corrected total charges increased from $121,854 to $185,100 between 2001 and 2015
      (net difference +$63,246, 51.9% relative increase, P<0.001). CONCLUSION: Women
      undergoing pelvic exenteration for gynecologic malignancies became more obese and
      comorbid during the study period. Pelvic exenteration for women with gynecologic 
      malignancies is associated with high morbidity and mortality as well as
      substantial treatment-related costs.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Matsuo, Koji
AU  - Matsuo K
AD  - Division of Gynecologic Oncology, Department of Obstetrics and Gynecology,
      University of Southern California, Los Angeles, CA, USA; Norris Comprehensive
      Cancer Center, University of Southern California, Los Angeles, CA, USA.
      Electronic address: koji.matsuo@med.usc.edu.
FAU - Mandelbaum, Rachel S
AU  - Mandelbaum RS
AD  - Division of Gynecologic Oncology, Department of Obstetrics and Gynecology,
      University of Southern California, Los Angeles, CA, USA.
FAU - Adams, Crystal L
AU  - Adams CL
AD  - Division of Gynecologic Oncology, Department of Obstetrics and Gynecology,
      University of Southern California, Los Angeles, CA, USA.
FAU - Roman, Lynda D
AU  - Roman LD
AD  - Division of Gynecologic Oncology, Department of Obstetrics and Gynecology,
      University of Southern California, Los Angeles, CA, USA; Norris Comprehensive
      Cancer Center, University of Southern California, Los Angeles, CA, USA.
FAU - Wright, Jason D
AU  - Wright JD
AD  - Division of Gynecologic Oncology, Department of Obstetrics and Gynecology,
      Columbia University College of Physicians and Surgeons, New York, NY, USA.
LA  - eng
PT  - Journal Article
DEP - 20190219
PL  - United States
TA  - Gynecol Oncol
JT  - Gynecologic oncology
JID - 0365304
OTO - NOTNLM
OT  - Gynecologic cancer
OT  - Morbidity
OT  - Mortality
OT  - Outcome
OT  - Pelvic exenteration
OT  - Trend
EDAT- 2019/02/23 06:00
MHDA- 2019/02/23 06:00
CRDT- 2019/02/23 06:00
PHST- 2018/12/17 00:00 [received]
PHST- 2019/01/29 00:00 [revised]
PHST- 2019/02/04 00:00 [accepted]
PHST- 2019/02/23 06:00 [pubmed]
PHST- 2019/02/23 06:00 [medline]
PHST- 2019/02/23 06:00 [entrez]
AID - S0090-8258(19)30105-2 [pii]
AID - 10.1016/j.ygyno.2019.02.002 [doi]
PST - aheadofprint
SO  - Gynecol Oncol. 2019 Feb 19. pii: S0090-8258(19)30105-2. doi:
      10.1016/j.ygyno.2019.02.002.