Extended pelvic resections for recurrent uterine and cervical cancer: out-of-the-box surgery

2008 ◽  
Vol 18 (5) ◽  
pp. 1139-1144 ◽  
Author(s):  
A. Caceres ◽  
S. M. Mourton ◽  
B. H. Bochner ◽  
S. R. Gerst ◽  
L. Liu ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Pelvic Exenteration ◽  
Pelvic Bone ◽  
High Dose ◽  
Total Pelvic Exenteration ◽  
Ileal Interposition ◽  
Reconstructive Procedures ◽  
Intraoperative Radiation ◽  
Iliac Vessel ◽  
Estimated Blood Loss

Patients with recurrent uterine and cervical cancer have poor prognoses. The objective of this study was to analyze the outcomes of patients with recurrent uterine and cervical cancer who had undergone attempted curative resection of pelvic bone, sidewall muscle, major blood vessels, and/or nerves. We reviewed the records of all 14 patients with recurrent uterine and cervical cancer who had extended pelvic resections at our institution between June 2000 and November 2006. Primary sites of disease were the uterus (11 patients) and cervix (3 patients). Tumor histology was as follows: adenocarcinoma, seven; squamous cell carcinoma, three; leiomyosarcoma, three; and adenosarcoma, one. Previous treatment included hysterectomy, 11; pelvic radiation, 9; chemotherapy, 9; and total pelvic exenteration, 2. Extended pelvic resections included removal of pelvic sidewall muscle, five; bone, five; common and/or external iliac vessel, five; femoral nerve, two; lumbosacral nerve root, one; and obturator nerve, one. Other procedures included total pelvic exenteration, three; posterior exenteration, two; and anterior exenteration, one. Complete resection with negative margins was obtained in 11 (78%) of 14 patients. Seven patients (50%) received high-dose rate intraoperative radiation therapy. Reconstructive procedures included continent or incontinent urinary diversion, four; femoral–femoral arterial bypass, two; myocutaneous flap, two; and urinary ileal interposition, one. Median total operating time was 628 min (range, 345–935 min) and median estimated blood loss was 900 mL (range, 300–16,000 mL). Seven patients (50%) had one or more major complication(s), including pelvic abscess, three; colonic fistula, two; massive intraoperative hemorrhage, one; postoperative bladder perforation, one; thrombosed femoral–femoral graft, one; and disruption of appendicocutaneous urinary anastomosis, one. At a median follow-up of 26 months (range, 5–84 months), ten patients (71%) are alive and four patients (29%) have died of disease at 8, 13, 33, and 42 months postoperatively

Total Pelvic Exenteration/Radical Hysterectomy for Cervical Cancer

1996 ◽  
pp. 29-30
Author(s):  
Ralph H. Hruban ◽  
William H. Westra ◽  
Timothy H. Phelps ◽  
Christina Isacson
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Pelvic Exenteration ◽  
Total Pelvic Exenteration

scholarly journals Robotic Total Pelvic Exenteration with Laparoscopic Rectus Flap: Initial Experience

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Brian R. Winters ◽  
Gary N. Mann ◽  
Otway Louie ◽  
Jonathan L. Wright
Keyword(s):  
Blood Loss ◽  
Open Surgery ◽  
Pelvic Exenteration ◽  
Locally Advanced ◽  
Descriptive Statistics ◽  
Initial Experience ◽  
Total Pelvic Exenteration ◽  
Surgical Morbidity ◽  
Pelvic Malignancies ◽  
Estimated Blood Loss

Total pelvic exenteration is a highly morbid procedure performed for locally advanced pelvic malignancies. We describe our experience with three patients who underwent robotic total pelvic exenteration with laparoscopic rectus flap and compare perioperative characteristics to our open experience. Demographic, tumor, operative, and perioperative factors were examined with descriptive statistics reported. Mean operative times were similar between the two groups. When compared to open total pelvic exenteration cases(n=9), median estimated blood loss, ICU stay, and hospital stay were all decreased. These data show robotic pelvic exenteration with laparoscopic rectus flap is technically feasible. The surgery was well tolerated with low blood loss and comparable operative times to the open surgery. Further study is needed to confirm the oncologic efficacy and the suggested improvement in surgical morbidity.

Surgical primary treatment of stage IVA cervical cancer: A multicenter retrospective study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15551-e15551
Author(s):  
Patrizio Damiani ◽  
Francesco Plotti ◽  
Marzio Angelo Zullo ◽  
Carlo De Cicco Nardone ◽  
Roberto Montera ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Retrospective Study ◽  
Pelvic Exenteration ◽  
Frozen Section ◽  
Colorectal Anastomosis ◽  
Disease Free Survival ◽  
Primary Treatment ◽  
Total Pelvic Exenteration ◽  
Systematic Lymphadenectomy ◽  
Paraaortic Lymph Nodes

e15551 Background: The aim of the present study is to describe feasibility, surgical technique, perioperative data, early and late complications of anterior and total pelvic exenteration after neoadjuvant chemotherapy as primary treatment for stage IVa cervical cancer. Methods: It is a retrospective study which included 73 consecutive patients affected by stage IVa cervical cancer who required anterior or total pelvic exenteration referred to 3 international gynaecologic oncology centres. The steps of this extirpative surgical procedure were: 1) staging laparotomy; 2) frozen section biopsy of the paraaortic lymph nodes; 3) systematic lymphadenectomy, radical hysterectomy with adnexectomy and total or anterior pelvic exenteration; 4) continent urinary diversions and low colorectal anastomosis if it was possible. Results: The treatment of patients affected by FIGO stage IVA cervical cancer remains one of the most complex procedures gynecologic oncologists are faced with. Our study focused on clinical and operative data , in terms of overall survival (OS) and disease free survival (DFS) at 5 years. 5-year OS of our series was 43%. Conclusions: The surgical treatment of stage IVA cervical cancer appears therefore a suitable and valid alternative. Stage IVA cervical cancer patients in good general condition, with a disease resectable with clear surgical margins, should be considered for primary exenteration in referral centers where the surgical experience to perform this procedure is available.

Resection of recurrent cervical cancer after total pelvic exenteration

2007 ◽  
Vol 17 (1) ◽  
pp. 137-140 ◽  
Author(s):  
S. M. Mourton ◽  
Y. Sonoda ◽  
N. R. Abu-Rustum ◽  
B. H. Bochner ◽  
R. R. Barakat ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Median Time ◽  
Pelvic Exenteration ◽  
Femoral Nerve ◽  
Psoas Muscle ◽  
Total Pelvic Exenteration ◽  
Recurrent Cervical Cancer ◽  
Time To Recurrence ◽  
Initial Recurrence ◽  
Alive With Disease

The objective of this study was to describe the management of patients with recurrent cervical cancer after total pelvic exenteration (TPE). We reviewed the records of patients who underwent TPE for recurrent cervical cancer between June 1992 and December 2003 and subsequently developed recurrent disease. Thirty-seven patients underwent TPE during the study period, and 25 (68%) subsequently developed recurrence proven by radiographic and/or biopsy studies. Recurrence sites included pelvic (12), inguinal (5), retroperitoneal (5), hepatic (4), vulva (2), perineum (1), transposed ovary (1), and lung (1). The median time to recurrence was 7 months (range 2–73 months), with 92% (23/25) occurring within 2 years of TPE. Management of recurrence was known in 21 of 25 patients, which included chemotherapy (10), surgical resection (7), and no further treatment (4). Surgically resected recurrences were isolated to the groin (2), vulva (2), perineum (1), transposed ovary (1), and psoas muscle (1). The four patients who underwent ovarian, perineal, and vulvar resections succumbed to their disease in a median time of 13 months (range 2–21 months). Of the two patients with surgically resected groin recurrences, one is alive with disease 21 months after initial recurrence and the other is alive without evidence of disease 85 months later. One patient had an isolated 4-cm recurrence involving the psoas muscle and the femoral nerve and is without the evidence of disease 9 months later. Resection of isolated recurrences after TPE is a reasonable option in selected patients, particularly in those with solitary inguinal metastases

scholarly journals Use of bakri balloon catheter and pedicled omental flap in combination for pelvic reconstruction after total pelvic exenteration

2021 ◽  
Author(s):  
samin almassian
Keyword(s):  
Cervical Cancer ◽  
Pelvic Exenteration ◽  
Balloon Catheter ◽  
Omental Flap ◽  
Advanced Cervical Cancer ◽  
Pelvic Reconstruction ◽  
Total Pelvic Exenteration ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Bakri Balloon

Our case was a middle-aged woman with advanced cervical cancer that underwent pelvic exenteration (PE) and then pelvic reconstruction (PR) with omental flap and bakri balloon placement.

scholarly journals Laparoscopic Total Pelvic Exenteration After Neoadjuvant Imatinib Therapy for Gastrointestinal Stromal Tumor of the Rectum: A Case Report

2017 ◽  
Vol 102 (5-6) ◽  
pp. 205-209
Author(s):  
Toshiya Nagasaki ◽  
Yosuke Fukunaga ◽  
Takashi Akiyoshi ◽  
Tsuyoshi Konishi ◽  
Yoshiya Fujimoto ◽  
...  
Keyword(s):  
Gastrointestinal Stromal Tumor ◽  
Pelvic Exenteration ◽  
Intraoperative Complications ◽  
Locally Advanced ◽  
Stromal Tumor ◽  
Resected Specimen ◽  
Total Pelvic Exenteration ◽  
Conversion To Open Surgery ◽  
Rectal Gist ◽  
Estimated Blood Loss

Total pelvic exenteration (TPE) may be the only curative procedure for locally advanced rectal gastrointestinal stromal tumor (GIST) that is contiguous with the adjacent organs and pelvic wall. There is no previous report of laparoscopic TPE for advanced rectal GIST. Here, we describe our experience of performing laparoscopic TPE on a locally advanced rectal GIST after neoadjuvant imatinib chemotherapy. A 62-year-old Japanese man was diagnosed with locally advanced rectal GIST that was contiguous with the seminal vesicles, prostate, and left pelvic sidewall. He received imatinib mesylate for 5 months, after which the mass had shrunk but was still contiguous with adjacent organs. We therefore needed to perform TPE, and we accomplished the operation laparoscopically. The total operative time was 540 minutes and estimated blood loss was 280 mL. There were no intraoperative complications and not required conversion to open surgery. The patient had his first stool on the first postoperative day and discharged on the 21st postoperative day with no major complication. Pathologic examination of the resected specimen revealed negative margins. The patient had further adjuvant imatinib chemotherapy and had no recurrence for 20 months postoperatively. Laparoscopic TPE appears to be minimally invasive surgery and safe in the present case of rectal GIST. This is the first report of a case in the world that underwent laparoscopic TPE for advanced rectal GIST.

scholarly journals The Relationship Between the Radiation Dose of Different Anatomic Bony Sites and Neutrophil Toxicity in Concurrent Chemoradiotherapy for Cervical Cancer

2020 ◽  
Author(s):  
Baozhong Zhang ◽  
Liming Xu ◽  
Zhiyan Liu ◽  
Yanlan Chai ◽  
Yuanjie Cao ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Dose ◽  
Linear Regression ◽  
Neutrophil Count ◽  
Concurrent Chemoradiotherapy ◽  
Pelvic Bone ◽  
High Dose ◽  
Analysis Model ◽  
Beam Radiation ◽  
Cutoff Values

Abstract Background: The purpose of this study was to verify the radiation dose of the pelvic bone marrow of different anatomical bony sitesand the incidence of neutrophil toxicity during the concurrent chemoradiotherapy for cervical cancer.Methods: There were 117 cervical cancer patients who received concurrent chemoradiotherapy included in this research. The radiotherapy includedexternal-beam radiation therapy (EBRT) and the brachytherapy. The dosimetric parameters included V5, V10, V20, V30, V40, V50, and Dmean. The final neutrophil count was defined as the lowest neutrophil count after 2 circles of concurrent chemotherapy, during or within 1 month after the treatment. The correlation between the dosimetric parameters and the lowest neutrophil count were analyzed by linear regression, the cutoff values of the dosimetric parameters were obtained using the ROC curves,the patients were divided into subgroups based on the cutoff values. The clinicopathologic features and the dosimetric parameters were included into the multivariate regression analysis model to further prove the correlation between the dosimetric parameters and the neutrophil toxicity. Data were assessed with IBM-SPSS software version 22.0, and all values of p<0.05were considered statistically significant.Results:The neutrophil toxicity (grade 1-4) rate was 58.97%. The linear regression showed the Dmean and V50 of Lumbosacral vertebrae(LS), the Dmean, V5, V10, V20, V30, V40 and V50 of the ilium correlated with the lowest neutrophil count, while none of the dosimetric parameters of the femoral correlated with the lowest neutrophil count.The multivariate analysis showed the V20, V30 and V50 of the LS, the Dmean, V5, V10, V20 and V30 of the ilium correlated well with the neutrophil toxicity; none of the dosimetric parameters of the femoral correlated with the neutrophil toxicity.Conclusion:During the process of concurrent chemoradiotherapy for cervical cancer, the volume of medium and high dose of LS and the volume of low and medium dose of ilium should be strictly limitedto reduce the risk of neutrophil toxicity, the Dmean of the ilium should also be taken into consideration. The dosimetric parameters of the femur could be ignored.Trial registration:This is a retrospective research, and it will be retrospectively registered.

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