Empty pelvis syndrome as a cause of major morbidity after pelvic exenteration: validation of a core data set - Summary - MDSpire

Empty pelvis syndrome as a cause of major morbidity after pelvic exenteration: validation of a core data set

  • By

  • Charles T West

  • Abhinav Tiwari

  • Julian Smith

  • Hideaki Yano

  • Malcolm A West

  • Alex H Mirnezami

  • Southampton Complex Cancer and Exenteration Team

  • G Ansell

  • A Bateman

  • C Birch

  • L Borthwick

  • H Cheema

  • V Dawson

  • K Donovan

  • J Douglas

  • R Exton

  • B George

  • J Green

  • M Hayes

  • G Hodges

  • L Ingram

  • C Lane

  • R Lewis

  • T Nash

  • M Nicolaou

  • B Patterson

  • E Ryan

  • Y Salem

  • D Spencer

  • K Stoddard

  • P Tapley

  • L Wodd

  • R Zaher

  • April 30, 2025

  • 0 min

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Objective:

To validate the PelvEx Collaborative core data set for empty pelvis syndrome (EPS) and assess its impact on major morbidity following pelvic exenteration (PE), emphasizing the significance of EPS in post-operative outcomes.

Key Findings:
  • EPS occurred in 32.1% of patients and was the leading cause of major morbidity.
  • Infected pelvic collections (23.5%) were linked to chronic sinus formation (OR 3.08, P = 0.01) and fistulae (P = 0.05).
  • Risk factors for EPS included external beam radiotherapy (OR 1.01 per 1 Gy, P = 0.01), sacrectomy (OR 3.78, P < 0.001), total cystectomy (OR 2.46, P = 0.001), and internal iliac vessel ligation (unilateral OR 1.94, P = 0.045; bilateral OR 3.65, P < 0.001).
  • Omentoplasty reduced pelvic bowel obstruction (OR 0.27, P = 0.004), while perineal flaps were associated with higher reconstruction-related morbidity (20.8% vs. 1.2%, P = 0.002).
Interpretation:

The study confirms EPS as a significant complication post-PE and validates the core data set for standardized reporting, highlighting the need for further validation in larger cohorts to improve clinical outcomes.

Limitations:
  • Potential confounding factors not fully addressed, which may affect the generalizability of the findings.
  • Exclusion of HRQoL and pelvic dead space volume changes due to lack of validated measurement instruments, potentially limiting the understanding of patient outcomes.
Conclusion:

The PelvEx Collaborative core data set standardizes EPS reporting, providing insights into acute and chronic complications, with biological mesh showing reduced morbidity compared to perineal flaps. Further validation in larger cohorts is essential.

Original Source(s)

Empty pelvis syndrome as a cause of major morbidity after pelvic exenteration: validation of a core data set

  • by Charles T West, Abhinav Tiwari, Julian Smith, Hideaki Yano, Malcolm A West, Alex H Mirnezami, Southampton Complex Cancer and Exenteration Team, G Ansell, A Bateman, C Birch, L Borthwick, H Cheema, V Dawson, K Donovan, J Douglas, R Exton, B George, J Green, M Hayes, G Hodges, L Ingram, C Lane, R Lewis, T Nash, M Nicolaou, B Patterson, E Ryan, Y Salem, D Spencer, K Stoddard, P Tapley, L Wodd, R Zaher

  • April 30, 2025

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