{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:04:33Z","timestamp":1787501073452,"version":"build-2736575974"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2021,11,3]],"date-time":"2021-11-03T00:00:00Z","timestamp":1635897600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,11,3]],"date-time":"2021-11-03T00:00:00Z","timestamp":1635897600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005788","name":"Medical University of Vienna","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005788","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Gynecol Obstet"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The aim of the present study is to investigate the prognostic significance of nutritional risk factors and sarcopenia on the outcome of patients with recurrent gynaecological malignancies treated by pelvic exenteration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively evaluated muscle body composite measurements based on pre-operative CT scans, nutritional risk factors as assessed by a validated pre-operative questionnaire, and clinical\u2013pathological parameters in 65 consecutive patients with recurrent gynaecological malignancies, excluding ovarian cancer, treated by pelvic exenteration at the Royal Marsden Hospital London. Predictive value for postoperative morbidity was investigated by logistic regression analyses. Relevant parameters were included in uni- and multivariate survival analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We found only (1) low muscle attenuation (MA)\u2014an established factor for muscle depletion\u2014and (2) moderate risk for malnutrition to be independently associated with shorter overall survival (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009\n                      <jats:italic>0.006<\/jats:italic>\n                      and\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009\n                      <jats:italic>0.008<\/jats:italic>\n                      , respectively). MA was significantly lower in overweight and obese patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009\n                      <jats:italic>0.04<\/jats:italic>\n                      ). Muscle body composite measurements were not predictive for post-operative morbidity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study suggests that pre-operative low MA and moderate risk for malnutrition are associated with shorter survival in patients with recurrent gynaecological malignancies treated with pelvic exenteration. Further studies are needed to validate these findings in larger cohorts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00404-021-06273-7","type":"journal-article","created":{"date-parts":[[2021,11,3]],"date-time":"2021-11-03T15:02:39Z","timestamp":1635951759000},"page":"1343-1352","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["The impact of nutritional risk factors and sarcopenia on survival in patients treated with pelvic exenteration for recurrent gynaecological malignancy: a retrospective cohort study"],"prefix":"10.1007","volume":"305","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9773-6430","authenticated-orcid":false,"given":"Veronika","family":"Seebacher","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Rockall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marielle","family":"Nobbenhuis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Aslam","family":"Sohaib","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Knogler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa M.","family":"Alvarez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desiree","family":"Kolomainen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John H.","family":"Shepherd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare","family":"Shaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desmond P.","family":"Barton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,11,3]]},"reference":[{"key":"6273_CR1","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1002\/1097-0142(194807)1:2<177::AID-CNCR2820010203>3.0.CO;2-A","volume":"1","author":"A Brunschwig","year":"1948","unstructured":"Brunschwig A (1948) Complete excision of pelvic viscera for advanced carcinoma: a one-stage abdominoperineal operation with end colostomy and bilateral ureteral implantation into the colon above the colostomy. Cancer 1:177\u2013183","journal-title":"Cancer"},{"key":"6273_CR2","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1016\/0002-9378(77)90521-X","volume":"129","author":"FN Rutledge","year":"1977","unstructured":"Rutledge FN, Smith JP, Wharton JT, O\u2019Quinn AG (1977) Pelvic exenteration: analysis of 296 patients. Am J Obstet Gynecol 129:881\u2013892","journal-title":"Am J Obstet Gynecol"},{"key":"6273_CR3","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.ygyno.2005.05.034","volume":"99","author":"JS Berek","year":"2005","unstructured":"Berek JS, Howe C, Lagasse LD, Hacker NF (2005) Pelvic exenteration for recurrent gynecologic malignancy: survival and morbidity analysis of the 45\u00a0year experience at UCLA. Gynecol Oncol 99:153\u2013159","journal-title":"Gynecol Oncol"},{"key":"6273_CR4","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1016\/S1470-2045(06)70903-2","volume":"7","author":"M H\u00f6ckel","year":"2006","unstructured":"H\u00f6ckel M, Dornh\u00f6fer N (2006) Pelvic exenteration for gynaecological tumours: achievements and unanswered questions. Lancet Oncol 7:837\u2013847","journal-title":"Lancet Oncol"},{"key":"6273_CR5","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/j.ygyno.2005.10.011","volume":"101","author":"GL Goldberg","year":"2006","unstructured":"Goldberg GL, Sukumvanich P, Einstein MH et al (2006) Total pelvic exenteration: the Albert Eintstein college of medicine\/montefiore medical center experience (1987 to 2003). Gynecol Oncol 101:261\u2013268","journal-title":"Gynecol Oncol"},{"key":"6273_CR6","doi-asserted-by":"publisher","first-page":"S9","DOI":"10.1016\/j.ygyno.2008.07.041","volume":"111","author":"L Ungar","year":"2008","unstructured":"Ungar L, Palfalvi L, Novak Z (2008) Primary pelvic exenteration in cervical cancer patients. Gynecol Oncol 111:S9\u2013S12","journal-title":"Gynecol Oncol"},{"key":"6273_CR7","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1097\/IGC.0000000000000884","volume":"27","author":"S Graves","year":"2017","unstructured":"Graves S, Seagle BL, Strohl AE et al (2017) Survival after pelvic exenteration for cervical cancer. A national cancer database study. Int J Gynecol Cancer 27:390\u2013395. https:\/\/doi.org\/10.1097\/IGC.0000000000000884","journal-title":"Int J Gynecol Cancer"},{"key":"6273_CR8","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1016\/j.ygyno.2016.10.018","volume":"143","author":"BL Seagle","year":"2016","unstructured":"Seagle BL, Dayno M, Strohl AE et al (2016) Survival after pelvic exenteration for uterine malignancy: a national cancer data base study. Gynecol Oncol 143:472\u2013478","journal-title":"Gynecol Oncol"},{"key":"6273_CR9","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1097\/IGC.0000000000000612","volume":"28","author":"M Dessole","year":"2016","unstructured":"Dessole M, Petrillo M, Lucidi A et al (2016) Quality of life in women after pelvic exenteration for gynecological malignancies\u2014a multicentric study. Int J Gyn Cancer 28:267\u2013273. https:\/\/doi.org\/10.1097\/IGC.0000000000000612","journal-title":"Int J Gyn Cancer"},{"key":"6273_CR10","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1016\/j.ygyno.2014.06.034","volume":"134","author":"S Westin","year":"2014","unstructured":"Westin S, Rallapalli V, Fellman B et al (2014) Overall survival after pelvic exenteration for gynecologic malignancy. Gynecol Oncol 134:546\u2013551","journal-title":"Gynecol Oncol"},{"key":"6273_CR11","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1200\/JCO.2012.45.2722","volume":"31","author":"L Martin","year":"2013","unstructured":"Martin L, Birdsell L, MacDonald N et al (2013) Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol 31:1539\u20131547","journal-title":"J Clin Oncol"},{"key":"6273_CR12","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/S1370-2045(08)70153-0","volume":"9","author":"CM Prado","year":"2008","unstructured":"Prado CM, Lieffers JR, McCargar LJ et al (2008) Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 9:629\u2013635. https:\/\/doi.org\/10.1016\/S1370-2045(08)70153-0","journal-title":"Lancet Oncol"},{"key":"6273_CR13","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.ejca.2015.12.030","volume":"57","author":"SS Shachar","year":"2016","unstructured":"Shachar SS, Williams GR, Muss HB, Nishijima TF (2016) Prognostic value of sarcopenia in adults with solid tumours: a meta-analysis and systematic review. Eur J Cancer 57:58\u201367","journal-title":"Eur J Cancer"},{"key":"6273_CR14","doi-asserted-by":"publisher","first-page":"1048","DOI":"10.1245\/s10434-016-5606-4","volume":"23","author":"Y Hirasawa","year":"2016","unstructured":"Hirasawa Y, Nakashima J, Yunaiyama D et al (2016) Sarcopenia as a novel preoperative prognostic predictor for survival in patients with bladder cancer undergoing radical cystectomy. Ann Surg Oncol 23:1048\u20131054","journal-title":"Ann Surg Oncol"},{"key":"6273_CR15","doi-asserted-by":"publisher","first-page":"e0140403","DOI":"10.1371\/journal.pone.0140403","volume":"10","author":"S Aust","year":"2015","unstructured":"Aust S, Knogler T, Pils D et al (2015) Skeletal muscle depletion and markers for cancer cachexia are strong prognostic factors in epithelial ovarian cancer. PLoS\u00a0One 10:e0140403","journal-title":"PLoS\u00a0One"},{"key":"6273_CR16","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1097\/IGC.0000000000000867","volume":"27","author":"H Bronger","year":"2016","unstructured":"Bronger H, Hederich P, Hapfelmeier A et al (2016) Sarcopenia in advanced serous ovarian cancer. Int J Gynecol Cancer 27:223\u2013232. https:\/\/doi.org\/10.1097\/IGC.0000000000000867","journal-title":"Int J Gynecol Cancer"},{"key":"6273_CR17","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1038\/bjc.2016.431","volume":"116","author":"LE Daly","year":"2017","unstructured":"Daly LE, Power DG, O\u2019Reilly A et al (2017) The impact of body composition parameters on ipilimumab toxicity and survival in patients with metastatic melanoma. Br J Cancer 116:310\u2013317. https:\/\/doi.org\/10.1038\/bjc.2016.431","journal-title":"Br J Cancer"},{"key":"6273_CR18","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1016\/S1470-2045(10)70218-7","volume":"12","author":"K Fearon","year":"2011","unstructured":"Fearon K, Strasser F, Anker SD et al (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12:489\u2013495","journal-title":"Lancet Oncol"},{"key":"6273_CR19","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1038\/nrc3829","volume":"14","author":"JM Argil\u00e9s","year":"2014","unstructured":"Argil\u00e9s JM, Busquets S, Stemmler B, L\u00f3pez-Soriano FJ (2014) Cancer cachexia: understanding the molecular basis. Nat Rev Cancer 14:754\u2013762","journal-title":"Nat Rev Cancer"},{"key":"6273_CR20","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1093\/ageing\/afq034","volume":"39","author":"AJ Cruz-Jentoft","year":"2010","unstructured":"Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al (2010) European working group on sarcopenia in older patients. Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing 39:412\u2013423","journal-title":"Age Ageing"},{"key":"6273_CR21","doi-asserted-by":"publisher","first-page":"2920","DOI":"10.1158\/1078-0432.CCR-08-2242","volume":"15","author":"CM Prado","year":"2009","unstructured":"Prado CM, Baracos VE, McCargar LJ et al (2009) Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res 15:2920\u20132926","journal-title":"Clin Cancer Res"},{"key":"6273_CR22","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1016\/j.ejso.2016.09.006","volume":"43","author":"N Lou","year":"2017","unstructured":"Lou N, Chi CH, Chen XD et al (2017) Sarcopenia in overweight and obese patients is a predictive factor for postoperative complication in gastric cancer: a prospective study. Eur J Surg Oncol 43:188\u2013195","journal-title":"Eur J Surg Oncol"},{"key":"6273_CR23","doi-asserted-by":"publisher","first-page":"1586","DOI":"10.1007\/s11605-016-3146-7","volume":"20","author":"Y Nishida","year":"2016","unstructured":"Nishida Y, Kato Y, Kudo M et al (2016) Preoperative sarcopenia strongly influences the risk of postoperative pancreatic fistula formation after pancreaticoduodenectomy. J Gastrointest Surg 20:1586\u20131594","journal-title":"J Gastrointest Surg"},{"key":"6273_CR24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10443615.2020.1867963","volume":"1","author":"OM Heath","year":"2021","unstructured":"Heath OM, Bryan SJ, Sohaib A, Barton DPJ (2021) Laparoscopic assessment improves case selection for exenterative surgery in recurrent cervical and endometrial cancer. J Obstet Gynaecol 1:1\u20139. https:\/\/doi.org\/10.1080\/10443615.2020.1867963","journal-title":"J Obstet Gynaecol"},{"key":"6273_CR25","unstructured":"American Society of Anesthesiologists. ASA physical status classification system. https:\/\/www.asahq.org\/resources\/clinical-information\/asa-physical-status-classification-system. Accessed on 12\/12\/2016."},{"key":"6273_CR26","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0148076","volume":"11","author":"CM Chang","year":"2016","unstructured":"Chang CM, Yin WY, Wie CK et al (2016) Age-adjusted chalson comorbidity index score as a risk measure of perioperative mortality before cancer surgery. PLoS\u00a0One 11:e0148076. https:\/\/doi.org\/10.1371\/journal.pone.0148076","journal-title":"PLoS\u00a0One"},{"key":"6273_CR27","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","volume":"250","author":"PA Clavien","year":"2009","unstructured":"Clavien PA, Barkun J, De Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications. Five-year experience. Ann Surg 250:187\u2013196","journal-title":"Ann Surg"},{"key":"6273_CR28","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1007\/s00520-014-2319-8","volume":"23","author":"C Shaw","year":"2015","unstructured":"Shaw C, Fleuret C, Pickard JM et al (2015) Comparison of a novel, simple nutrition screening tool for adult oncology inpatients and the malnutrition screening tool (MST) against the patient-generated subjective global assessment (PG-SGA). Support Care Cancer 23:47\u201354. https:\/\/doi.org\/10.1007\/s00520-014-2319-8 (Epub 2014 Jun 20)","journal-title":"Support Care Cancer"},{"key":"6273_CR29","doi-asserted-by":"publisher","first-page":"997","DOI":"10.1139\/H08-075","volume":"33","author":"M Mourtzakis","year":"2008","unstructured":"Mourtzakis M, Prado CMM, Lieffers JR et al (2008) A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab 33:997\u20131006","journal-title":"Appl Physiol Nutr Metab"},{"key":"6273_CR30","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1016\/j.ygyno.2016.05.027","volume":"142","author":"A Kumar","year":"2016","unstructured":"Kumar A, Moynagh MR, Multinu F et al (2016) Muscle composition measured by CT scan is a measurable predictor of overall survival in advanced ovarian cancer. Gynecol Oncol 142:311\u2013316","journal-title":"Gynecol Oncol"},{"key":"6273_CR31","doi-asserted-by":"publisher","DOI":"10.1002\/jcsm.12155","author":"DPJ Van Dijk","year":"2016","unstructured":"Van Dijk DPJ, Bakens MJAM, Coolsen MME et al (2016) Low skeletal muscle radiation attenuation and visceral adiposity are associated with overall survival and surgical site infections in patients with pancreatic cancer. J Cachexia Sarcopenia Muscle. https:\/\/doi.org\/10.1002\/jcsm.12155","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"6273_CR32","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1038\/ejcn.2014.117","volume":"68","author":"JA Batsis","year":"2014","unstructured":"Batsis JA, Mackenzie TA, Barre LK et al (2014) Sarcopenia, sarcopenic obesity and mortality in older adults: results from the national health and nutrition examination survey III. Eur J Clin Nutr 68:1001\u20131007","journal-title":"Eur J Clin Nutr"},{"key":"6273_CR33","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1002\/bjs.10063","volume":"103","author":"N Pecorelli","year":"2016","unstructured":"Pecorelli N, Carrara G, De Cobelli F et al (2016) Effect of sarcopenia and visceral obesity on mortality and pancreatic fistula following pancreatic cancer surgery. BJS 103:434\u2013442","journal-title":"BJS"},{"key":"6273_CR34","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1007\/s00423-016-1490-4","volume":"401","author":"FF Chen","year":"2016","unstructured":"Chen FF, Zhang FY, Zhou XY et al (2016) Role of frailty and nutritional status in predicting complications following total gastrectomy with D2 lymphadenectomy in patients with gastric cancer: a prospective study. Langenbecks Arch Surg 401:813\u2013822","journal-title":"Langenbecks Arch Surg"},{"key":"6273_CR35","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1097\/SLA.0000000000003533","volume":"270","author":"Pelv Ex Collaborative","year":"2019","unstructured":"Pelv Ex Collaborative (2019) Pelvic exenteration for advanced nonrectal pelvic malignancy. Ann Surg 270:899\u2013905. https:\/\/doi.org\/10.1097\/SLA.0000000000003533","journal-title":"Ann Surg"},{"issue":"04","key":"6273_CR36","first-page":"396","volume":"77","author":"V Seebacher","year":"2017","unstructured":"Seebacher V, Nobbenhuis M, Rockall A, Sohaib A, Shepherd J, Barton D (2017) Pr\u00e4operative mangelern\u00e4hrung und sarkopenie\u2014risikofaktoren f\u00fcr ein k\u00fcrzeres \u00fcberleben von patientinnen nach pelviner exenteration? Geburtshilfe Frauenheilk 77(04):396\u2013405","journal-title":"Geburtshilfe Frauenheilk"},{"issue":"Suppl 1","key":"6273_CR37","first-page":"24","volume":"17","author":"V Seebacher","year":"2017","unstructured":"Seebacher V, Rockall A, Nobbenhuis M, Sohaib A, Knogler T, Alvarez-Lopez R, Kolomainen D, Shaw C, Shepherd J, Barton DP (2017) Malnutrition and sarcopenia: risk factors for shorter survival after pelvic exenteration for recurrent gynecological malignancy. Proceedings of the international cancer imaging society (ICIS) 17th annual teaching course, Berlin, Germany, 02\u201304 October 2017. Cancer Imaging 17(Suppl 1):24 (Published online 2017 Sep 7)","journal-title":"Cancer Imaging"},{"key":"6273_CR38","unstructured":"Seebacher V, Rockall A, Nobbenhuis M, Lopez RMA, Sohaib A, Knogler T, Barton D (2017) Malnutrition and sarcopenia: risk factors for shorter survival in patients treated with pelvic exenteration for recurrent gynecological malignancy. 20th International Meeting of the European Society of Gynaecological Oncology, Vienna, Austria, November 4\u20137, 2017 Int J Gyn Cancer 27(Suppl 4)"}],"container-title":["Archives of Gynecology and Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00404-021-06273-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00404-021-06273-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00404-021-06273-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,17]],"date-time":"2022-04-17T06:14:13Z","timestamp":1650176053000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00404-021-06273-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,3]]},"references-count":38,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,5]]}},"alternative-id":["6273"],"URL":"https:\/\/doi.org\/10.1007\/s00404-021-06273-7","relation":{},"ISSN":["1432-0711"],"issn-type":[{"value":"1432-0711","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,3]]},"assertion":[{"value":"5 October 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 September 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 November 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"We declare that we have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study has been carried out with the approval of the appropriate ethical committee, the Committee for Clinical Research of the Royal Marsden Hospital NHS Foundation Trust. The committee waived the requirement to obtain informed consent.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}