IMPROVEMENTS IN PELVIC EXENTERATION - FACTORS RESPONSIBLE FOR REDUCING MORBIDITY AND MORTALITY

Background: Since pelvic exenteration for the treatment of recurrent g ynecologic malignancy first was described, reported rates of morbidity and mortality have declined steadily. However, the factors responsibl e for this decline have never been clearly delineated. Methods: We rev iewed the charts of 154 patients who underwent pelvic exenteration for gynecologic malignancy between 1954 and 1994. Charts were abstracted for details of the surgical procedure, pathologic findings, postoperat ive management, short- and long-term complications, time to recurrence , and overall survival. Results: Seventy-two patients (47%) experience d 95 identifiable postoperative complications, resulting in death in 2 2 patients (14%). The rate of infectious complications declined to a s tatistically significant degree between the first two decades and latt er two decades of the study (odds ratio [OR] 0.28, 95% CI 0.11-0.69). The use of routine prophylactic antibiotics was associated with this d ecline in infectious complications (OR 0.25, 95% CI 0.07-0.83). The us e of preoperative subcutaneous heparin was associated with a reduction in thrombotic complications from 5 of 100 patients to 0 of 54 patient s (P =.11), as well as a significant reduction in overall risk of comp lications (OR 0.53, 95% CI 0.33-0.85) and risk of postoperative mortal ity (OR 0.19, 95% CI 0.05-0.80). There was a significant reduction in overall risk of postoperative complications with both intensive care u nit monitoring postoperatively (OR 0.65, 95% CI 0.43-0.99) and routine postoperative monitoring with a pulmonary artery catheter (OR 0.61, 9 5% CI 0.38-0.98). Conclusions: Routine use of prophylactic antibiotics , prophylactic subcutaneous heparin, and intensive postoperative monit oring appear to have reduced morbidity from pelvic exenteration.