The empty pelvis syndrome: a core data set from the PelvEx collaborative
Authors:   PelvEx Collaborative, Mirnezami A H , Drami I , Glyn T , Sutton P A , Tiernan J , Behrenbruch C , Guerra G , Waters P S , Woodward N , Applin S , Charles S J , Rose S A , Denys A , Pape E , van Ramshorst G H , Baker D , Bignall E , Blair I , Davis P , Edwards T , Jackson K , Leendertse P G , Love-Mott E , MacKenzie L , Martens F , Meredith D , Nettleton S E , Trotman M P , van Hecke J J M , Weemaes A M J , Abecasis N , Angenete E , Aziz O , Bacalbasa N , Barton D , Baseckas G , Beggs A , Brown K , Buchwald P , Burling D , Burns E , Caycedo-Marulanda A , Chang G J , Coyne P E , Croner R S , Daniels I R , Denost Q D , Drozdov E , Eglinton T , Espín-Basany E , Evans M D , Flatmark K , Folkesson J , Frizelle F A , Gallego M A , Gil-Moreno A , Goffredo P , Griffiths B , Gwenaël F , Harris D A , Iversen L H , Kandaswamy G V , Kazi M , Kelly M E , Kokelaar R , Kusters M , Langheinrich M C , Larach T , Lydrup M L , Lyons A , Mann C , McDermott F D , Monson J R T , Neeff H , Negoi I , Ng J L , Nicolaou M , Palmer G , Parnaby C , Pellino G , Peterson A C , Quyn A , Rogers A , Rothbarth J , Abu Saadeh F , Saklani A , Sammour T , Sayyed R , Smart N J , Smith T , Sorrentino L , Steele S R , Stitzenberg K , Taylor C , Teras J , Thanapal M R , Thorgersen E , Vasquez-Jimenez W , Waller J , Weber K , Wolthuis A , Winter D C , Branagan G , Vimalachandran D , Aalbers A G J , Abdul Aziz N , Abraham-Nordling M , Akiyoshi T , Alahmadi R , Alberda W , Albert M , Andric M , Angeles M , Antoniou A , Armitage J , Auer R , Austin K K , Aytac E , Baker R P , Bali M , Baransi S , Bebington B , Bedford M , Bednarski B K , Beets G L , Berg P L , Bergzoll C , Biondo S , Boyle K , Bordeianou L , Brecelj E , Bremers A B , Brunner M , Bui A , Burgess A , Burger J W A , Campain N , Carvalhal S , Castro L , Ceelen W , Chan K K L , Chew M H , Chok A K , Chong P , Christensen H K , Clouston H , Collins D , Colquhoun A J , Constantinides J , Corr A , Coscia M , Cosimelli M , Cotsoglou C , Damjanovic L , Davies M , Davies R J , Delaney C P , de Wilt J H W , Deutsch C , Dietz D , Domingo S , Dozois E J , Duff M , Egger E , Enrique-Navascues J M , Espín-Basany E , Eyjólfsdóttir B , Fahy M , Fearnhead N S , Fichtner-Feigl S , Fleming F , Flor B , Foskett K , Funder J , García-Granero E , García-Sabrido J L , Gargiulo M , Gava V G , Gentilini L , George M L , George V , Georgiou P , Ghosh A , Ghouti L , Giner F , Ginther N , Glover T , Golda T , Gomez C M , Harris C , Hagemans J A W , Hanchanale V , Harji D P , Helbren C , Helewa R M , Hellawell G , Heriot A G , Hochman D , Hohenberger W , Holm T , Holmström A , Hompes R , Hornung B , Hurton S , Hyun E , Ito M , Jenkins J T , Jourand K , Kaffenberger S , Kapur S , Kanemitsu Y , Kaufman M , Kelley S R , Keller D S , Kersting S , Ketelaers S H J , Khan M S , Khaw J , Kim H , Kim H J , Kiran R , Koh C E , Kok N F M , Kontovounisios C , Kose F , Koutra M , Kraft M , Kristensen H Ø , Kumar S , Lago V , Lakkis Z , Lampe B , Larsen S G , Larson D W , Law W L , Laurberg S , Lee P J , Limbert M , Loria A , Lynch A C , Mackintosh M , Mantyh C , Mathis K L , Margues C F S , Martinez A , Martling A , Meijerink W J H J , Merchea A , Merkel S , Mehta A M , McArthur D R , McCormick J J , McGrath J S , McPhee A , Maciel J , Malde S , Manfredelli S , Mikalauskas S , Modest D , Morton J R , Mullaney T G , Navarro A S , Neto J W M , Nguyen B , Nielsen M B , Nieuwenhuijzen G A P , Nilsson P J , Nordkamp S , O’Dwyer S T , Paarnio K , Pappou E , Park J , Patsouras D , Peacock O , Pfeffer F , Piqeur F , Pinson J , Poggioli G , Proud D , Quinn M , Oliver A , Radwan R W , Rajendran N , Rao C , Rasheed S , Rasmussen P C , Rausa E , Regenbogen S E , Reims H M , Renehan A , Rintala J , Rocha R , Rochester M , Rohila J , Rottoli M , Roxburgh C , Rutten H J T , Safar B , Sagar P M , Sahai A , Schizas A M P , Schwarzkopf E , Scripcariu D , Scripcariu V , Seifert G , Selvasekar C , Shaban M , Shaikh I , Shida D , Simpson A , Skeie-Jensen T , Smart P , Smith J J , Solbakken A M , Solomon M J , Sørensen M M , Spasojevic M , Steffens D , Stocchi L , Stylianides N A , Swartling T , Sumrien H , Swartking T , Takala H , Tan E J , Taylor D , Tejedor P , Tekin A , Tekkis P P , Thaysen H V , Thurairaja R , Toh E L , Tsarkov P , Tolenaar J , Tsukada Y , Tsukamoto S , Tuech J J , Turner G , Turner W H , Tuynman J B , Valente M , van Rees J , van Zoggel D , Vásquez-Jiménez W , Verhoef C , Vierimaa M , Vizzielli G , Voogt E L K , Uehara K , Wakeman C , Warrier S , Wasmuth H H , Weiser M R , Westney O L , Wheeler J M D , Wild J , Wilson M , Yano H , Yip B , Yip J , Yoo R N , Zappa M A 
Published: March 2024

Abstract

Background
Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored.

Method
Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition.

Results
One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus—where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed.

Conclusions
EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.