Complications and recurrence after pelvic exenteration for gynecologic malignancies: Analysis of surgical complications from the COREPEX study

Objective: This study aimed to assess intra-operative, short-term, and long-term morbidity and develop a score predicting post-operative complications after pelvic exenteration for gynecologic cancer. Methods: This was a retrospective, multi-center, international study conducted in tertiary referral centers for gynecologic oncology. The inclusion criteria included cervical, vaginal, vulvar, or endometrial cancer; anterior/total pelvic exenteration performed between January 2005 and March 2023; curative/palliative intent; with or without laterally extended endopelvic/pelvic resection. Logistic regression adjusted for co-variables and a score predictive of severe post-operative complications based on the multi-variable analysis were developed. Results: A total of 862 patients were included. Seven patients (0.8%) had severe intra-operative complications, and no patient experienced intra-operative death. A total of 225 patients (26.1%) had severe early post-operative complications and 27 (3.1%) died within 30 days. The most frequent severe early post-operative complications were pelvic abscess/collection (23.4%) and urostomy leak/fistula (13.4%). A total of 87 patients (10.1%) had severe late post-operative complications, and 16 patients (1.8%) died between 31 and 180 days. The most frequent severe late post-operative complications were pelvic abscess/collection (21.6%) and benign ureteric stricture (13.5%). Risk factors independently associated with severe early and late post-operative complications were no previous recurrences, American Society of Anesthesiologists score >1, total pelvic exenteration, infra-levator pelvic exenteration, laterally extended endopelvic/pelvic resection; and infra-levator pelvic exenteration and laterally extended endopelvic/pelvic resection, respectively. The COREPEX predictive score identified 4 groups with significantly different risk of severe post-operative complications (p < .001). Conclusions: Patients undergoing anterior or total pelvic exenteration have a low risk of intra-operative but a remarkable risk of major post-operative complications. No intra-operative death was recorded, and post-operative mortality was low. The COREPEX score predicting the risk of post-operative complications can be used to counsel patients and for future studies.