Abstract：
OBJECTIVE: To compare perioperative outcomes in patients undergoing pelvic exenteration for gynecologic malignancies before and after implementation of Enhanced Recovery After Surgery (ERAS) protocols.
METHODS: We performed an institutional retrospective cohort study of patients undergoing pelvic exenteration for gynecologic malignancies before (1/1/2006-12/30/2014) and after (1/1/2015-6/30/2023) ERAS implementation. We described ERAS compliance rates. We compared outcomes up to 60 days post-exenteration. Complication grades were defined by the Clavien-Dindo system.
RESULTS: Overall, 105 women underwent pelvic exenteration; 74 (70.4%) in the pre-ERAS and 31 (29.5%) in the ERAS cohorts. There were no differences between cohorts in age, body mass index, race, primary disease site, type of exenteration, urinary diversion, or vaginal reconstruction. All patients had complications, with at least one grade II+ complication in 94.6% of pre-ERAS and 90.3% of ERAS patients. The ERAS cohort had more grade I-II gastrointestinal (61.3% vs 21.6%, p < 0.001) and hematologic (61.3% vs 36.5%, p = 0.030) and grade III-IV renal (29.0% vs 12.2%, p = 0.048) and wound (45.2% vs 18.9%, p = 0.008) complications compared to the pre-ERAS cohort. ERAS patients had a higher rate of ileus (38.7% vs 10.8%, p = 0.002), urinary leak (22.6% vs 5.4%, p = 0.014), pelvic abscess (35.5% vs 10.8%, p = 0.005), postoperative bleeding requiring intervention (61.3% vs 28.4%, p = 0.002), and readmission (71.4% vs 46.5%, p = 0.025). Median ERAS compliance was 60%.
CONCLUSIONS: Pelvic exenteration remains a morbid procedure, and complications were more common in ERAS compared to pre-ERAS cohorts. ERAS protocols should be optimized and tailored to the complexity of pelvic exenteration compared to standard gynecologic oncology ERAS pathways.
METHODS: We performed an institutional retrospective cohort study of patients undergoing pelvic exenteration for gynecologic malignancies before (1/1/2006-12/30/2014) and after (1/1/2015-6/30/2023) ERAS implementation. We described ERAS compliance rates. We compared outcomes up to 60 days post-exenteration. Complication grades were defined by the Clavien-Dindo system.
RESULTS: Overall, 105 women underwent pelvic exenteration; 74 (70.4%) in the pre-ERAS and 31 (29.5%) in the ERAS cohorts. There were no differences between cohorts in age, body mass index, race, primary disease site, type of exenteration, urinary diversion, or vaginal reconstruction. All patients had complications, with at least one grade II+ complication in 94.6% of pre-ERAS and 90.3% of ERAS patients. The ERAS cohort had more grade I-II gastrointestinal (61.3% vs 21.6%, p < 0.001) and hematologic (61.3% vs 36.5%, p = 0.030) and grade III-IV renal (29.0% vs 12.2%, p = 0.048) and wound (45.2% vs 18.9%, p = 0.008) complications compared to the pre-ERAS cohort. ERAS patients had a higher rate of ileus (38.7% vs 10.8%, p = 0.002), urinary leak (22.6% vs 5.4%, p = 0.014), pelvic abscess (35.5% vs 10.8%, p = 0.005), postoperative bleeding requiring intervention (61.3% vs 28.4%, p = 0.002), and readmission (71.4% vs 46.5%, p = 0.025). Median ERAS compliance was 60%.
CONCLUSIONS: Pelvic exenteration remains a morbid procedure, and complications were more common in ERAS compared to pre-ERAS cohorts. ERAS protocols should be optimized and tailored to the complexity of pelvic exenteration compared to standard gynecologic oncology ERAS pathways.
摘要：
目的：比较妇科恶性肿瘤盆腔切除术患者在实施强化恢复手术（ERAS）方案前后的围手术期结局。
方法：我们对在ERAS实施之前（2006年1月1日至2014年12月30日）和之后（2015年1月1日至2023年6月30日）接受盆腔切除术的妇科恶性肿瘤患者进行了回顾性队列研究。我们描述了ERAS合规率。我们比较了直到60天的结果。并发症等级由Clavien-Dindo系统定义。
结果：总体而言，105名女性接受了盆腔切除术；ERAS前74名(70.4%)，ERAS队列31名(29.5%)。队列之间的年龄没有差异，身体质量指数,种族,原发病部位,类型的放逐，尿流改道,或阴道重建。所有患者均有并发症,在94.6%的前ERAS患者和90.3%的ERAS患者中至少有一个II级+并发症。ERAS队列具有更多的I-II级胃肠道（61.3％vs21.6％，p<0.001）和血液学（61.3%vs36.5%，p=0.030）和III-IV级肾脏（29.0%vs12.2%，p=0.048）和伤口（45.2%vs18.9%，p=0.008）与ERAS前队列相比的并发症。ERAS患者的肠梗阻发生率较高(38.7%vs10.8%,p=0.002),尿漏（22.6%vs5.4%，p=0.014),盆腔脓肿（35.5%vs10.8%，p=0.005),术后出血需要干预（61.3%vs28.4%，p=0.002),和再入院(71.4%和46.5%，p=0.025)。ERAS依从性中位数为60%。
结论：盆腔切除术仍然是一种病态程序，与ERAS前队列相比,ERAS中的并发症更为常见.与标准妇科肿瘤ERAS途径相比，ERAS方案应针对盆腔切除术的复杂性进行优化和调整。
方法：我们对在ERAS实施之前（2006年1月1日至2014年12月30日）和之后（2015年1月1日至2023年6月30日）接受盆腔切除术的妇科恶性肿瘤患者进行了回顾性队列研究。我们描述了ERAS合规率。我们比较了直到60天的结果。并发症等级由Clavien-Dindo系统定义。
结果：总体而言，105名女性接受了盆腔切除术；ERAS前74名(70.4%)，ERAS队列31名(29.5%)。队列之间的年龄没有差异，身体质量指数,种族,原发病部位,类型的放逐，尿流改道,或阴道重建。所有患者均有并发症,在94.6%的前ERAS患者和90.3%的ERAS患者中至少有一个II级+并发症。ERAS队列具有更多的I-II级胃肠道（61.3％vs21.6％，p<0.001）和血液学（61.3%vs36.5%，p=0.030）和III-IV级肾脏（29.0%vs12.2%，p=0.048）和伤口（45.2%vs18.9%，p=0.008）与ERAS前队列相比的并发症。ERAS患者的肠梗阻发生率较高(38.7%vs10.8%,p=0.002),尿漏（22.6%vs5.4%，p=0.014),盆腔脓肿（35.5%vs10.8%，p=0.005),术后出血需要干预（61.3%vs28.4%，p=0.002),和再入院(71.4%和46.5%，p=0.025)。ERAS依从性中位数为60%。
结论：盆腔切除术仍然是一种病态程序，与ERAS前队列相比,ERAS中的并发症更为常见.与标准妇科肿瘤ERAS途径相比，ERAS方案应针对盆腔切除术的复杂性进行优化和调整。
