The role of imaging in pelvic exenteration for gynecological cancers

Pelvic exenteration (PE) is one of the most challenging gynecologic oncologic surgeries and is an overriding term for different procedures that entail radical en bloc resection of the female reproductive organs and removal of additional adjacent affected pelvic organs (bladder, rectum, anus, etc.) with concomitant surgical reconstruction to restore bodily functions. Multimodality cross-sectional imaging with MRI, PET/CT, and CT plays an integral part in treatment decision-making, not only for the appropriate patient selection but also for surveillance after surgery. The purpose of this review is to provide a brief background on pelvic exenteration in gynecologic cancers and to familiarize the reader with the critical radiological aspects in the evaluation of patients for this complex procedure. The focus of this review will be on how imaging can aid in treatment planning and guide management.

Download Full-text

Longitudinal quality of life (QOL) and sexual functioning in women undergoing pelvic exenteration for gynecologic malignancies.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.5608 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 5608-5608 ◽

Cited By ~ 1

Author(s):

Pamela T. Soliman ◽

Charlotte C. Sun ◽

Shannon Neville Westin ◽

Lois M. Ramondetta ◽

Diane C. Bodurka ◽

...

Keyword(s):

Social Support ◽

Body Image ◽

Functional Status ◽

Sexual Functioning ◽

Pelvic Exenteration ◽

En Bloc Resection ◽

Bloc Resection ◽

High Morbidity ◽

En Bloc ◽

Reconstruction Methods

5608 Background: Pelvic exenteration (PE) is en bloc resection of the pelvic organs including bladder, vagina, and rectum to treat central recurrence of a gynecologic malignancy. While this procedure has high morbidity, it is the only option for cure in some patients. The goal of this study was to assess QOL and sexual functioning in women who underwent PE with vaginal and/or bladder reconstruction. Methods: All patients were enrolled prior to PE. Surveys included the SF-12 (functional status), BIS (body image), SAQ (sexual functioning), SWD (satisfaction with decision), CES-D (depression), Stoma QOL, and DUFSS completed preoperatively (preop) and post-operatively at 4-6 wks, 6 mo, 1 yr, and 2 yrs. Descriptive statistics, chi-square, Mann-Whitney, and Kruskal Wallis tests were used to evaluate the data. Results: Between 2008 and 2012, 39 women participated. Median age was 56.7 yrs. Mean physical functional status scores (SF-12) declined through 6 mo postop, with improvements at 1 and 2 yrs (p=.002) but did not reach preop levels. SF-12 mental functioning scores declined immediately postop but returned to baseline by 6 mo. BIS was significantly worse at 1ys (p=0.02) and 2 yrs (p=0.025). Mean depression (CES-D) scores decrease but remained above the clinical cutoff of 17 at 6 mo. Poor sexual function was noted preop and did not improve. High scores for social support (DUFSS) remained constant. Stoma QOL improved in the first 2 yrs but not significantly. Pts reported high satisfaction with the decision to undergo PE, which did not change over time. Conclusions: While a majority of women remained satisfied with their decision to undergo PE, the procedure was associated with depression, worsening physical functioning and poor body image despite stable social support. Interventions are currently under development to improve QOL in this patient population. [Table: see text]

Download Full-text

Total Pelvic Exenteration for Gynecologic Malignancies

International Journal of Surgical Oncology ◽

10.1155/2012/693535 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 10

Author(s):

Elisabeth J. Diver ◽

J. Alejandro Rauh-Hain ◽

Marcela G. del Carmen

Keyword(s):

Pelvic Exenteration ◽

Gynecologic Oncology ◽

Evaluation Process ◽

En Bloc Resection ◽

Bloc Resection ◽

Total Pelvic Exenteration ◽

Gynecologic Malignancies ◽

En Bloc ◽

Recurrent Cancer ◽

Locally Recurrent

Total pelvic exenteration (PE) is a radical operation, involving en bloc resection of pelvic organs, including reproductive structures, bladder, and rectosigmoid. In gynecologic oncology, it is most commonly indicated for the treatment of advanced primary or locally recurrent cancer. Careful patient selection and counseling are of paramount importance when considering someone for PE. Part of the evaluation process includes comprehensive assessment to exclude unresectable or metastatic disease. PE can be curative for carefully selected patients with gynecologic cancers. Major complications can be seen in as many as 50% of patients undergoing PE, underscoring the need to carefully discuss risks and benefits of this procedure with patients considering exenterative surgery.

Download Full-text

Osteosarcoma of the spine: prognostic variables for local recurrence and overall survival, a multicenter ambispective study

Journal of Neurosurgery Spine ◽

10.3171/2015.11.spine15870 ◽

2016 ◽

Vol 25 (1) ◽

pp. 59-68 ◽

Cited By ~ 27

Author(s):

Mark B. Dekutoski ◽

Michelle J. Clarke ◽

Peter Rose ◽

Alessandro Luzzati ◽

Laurence D. Rhines ◽

...

Keyword(s):

Local Recurrence ◽

Median Survival ◽

Survival Data ◽

En Bloc Resection ◽

Bloc Resection ◽

Prognostic Variables ◽

En Bloc ◽

Cross Sectional ◽

Perioperative Morbidity ◽

Tumor Patient

OBJECTIVE Primary spinal osteosarcomas are rare and aggressive neoplasms. Poor outcomes can occur, as obtaining marginal margins is technically demanding; further Enneking-appropriate en bloc resection can have significant morbidity. The goal of this study is to identify prognostic variables for local recurrence and mortality in surgically treated patients diagnosed with a primary osteosarcoma of the spine. METHODS A multicenter ambispective database of surgically treated patients with primary spine osteosarcomas was developed by AOSpine Knowledge Forum Tumor. Patient demographic, diagnosis, treatment, perioperative morbidity, local recurrence, and cross-sectional survival data were collected. Tumors were classified in 2 cohorts: Enneking appropriate (EA) and Enneking inappropriate (EI), as defined by pathology margin matching Enneking-recommended surgical margins. Prognostic variables were analyzed in reference to local recurrence and survival. RESULTS Between 1987 and 2012, 58 patients (32 female patients) underwent surgical treatment for primary spinal osteosarcoma. Patients were followed for a mean period of 3.5 ± 3.5 years (range 0.5 days to 14.3 years). The median survival for the entire cohort was 6.7 years postoperative. Twenty-four (41%) patients died, and 17 (30%) patients suffered a local recurrence, 10 (59%) of whom died. Twenty-nine (53%) patients underwent EA resection while 26 (47%) patients underwent EI resection with a postoperative median survival of 6.8 and 3.7 years, respectively (p = 0.048). EI patients had a higher rate of local recurrence than EA patients (p = 0.001). Patient age, previous surgery, biopsy type, tumor size, spine level, and chemotherapy timing did not significantly influence recurrence and survival. CONCLUSIONS Osteosarcoma of the spine presents a significant challenge, and most patients die in spite of aggressive surgery. There is a significant decrease in recurrence and an increase in survival with en bloc resection (EA) when compared with intralesional resection (EI). The effect of adjuvant and neoadjuvant chemotherapeutics, as well as method of biopsy, requires further exploration.

Download Full-text

Pelvic exenteration with en bloc resection of the pelvic sidewall and intraoperative electron beam radiotherapy with Mobetron® for locally advanced rectal cancer

Techniques in Coloproctology ◽

10.1007/s10151-017-1649-1 ◽

2017 ◽

Vol 21 (6) ◽

pp. 493-495 ◽

Cited By ~ 1

Author(s):

K. Rangarajan ◽

R. Bhome ◽

N. Bateman ◽

A. Naga ◽

M. Simon ◽

...

Keyword(s):

Rectal Cancer ◽

Electron Beam ◽

Pelvic Exenteration ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

En Bloc Resection ◽

Locally Advanced Rectal Cancer ◽

Bloc Resection ◽

En Bloc ◽

Electron Beam Radiotherapy

Download Full-text

Pelvic Exenteration in Gynecologic Cancer: La Paz University Hospital Experience

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000435 ◽

2015 ◽

Vol 25 (6) ◽

pp. 1109-1114 ◽

Cited By ~ 3

Author(s):

Elisa Moreno-Palacios ◽

Maria D. Diestro ◽

Javier De Santiago ◽

Alicia Hernández ◽

Ignacio Zapardiel

Keyword(s):

Pelvic Exenteration ◽

Gynecologic Cancer ◽

Cancer Recurrence ◽

En Bloc Resection ◽

Bloc Resection ◽

University Hospital ◽

High Morbidity ◽

En Bloc ◽

Permanent Colostomy ◽

La Paz

BackgroundPelvic exenteration is an ultraradical surgery involving the en bloc resection of the pelvic organs, including the internal reproductive organs, the distal urinary tract (ureters, bladder, urethra), and/or anorectum. It is mainly applied as a salvage surgery for recurrent gynecologic tumors of any origin (vulva, vagina, cervix, uterine, and also ovary). Our aim was to establish the most favorable cases for this type of surgery by means of a review of our institution experience.MethodsRetrospective analyses of all patients treated with pelvic exenteration for recurrent gynecologic cancer from 2008 to 2014 at La Paz University Hospital.ResultsTen patients underwent pelvic exenteration for recurrent gynecologic cancers including uterine, cervical, vaginal, vulvar, and ovarian cancer. All patients had received prior treatment: surgery, radiotherapy, and/or chemotherapy. Eight patients underwent total pelvic exenteration, one anterior and one posterior pelvic exenteration. Urinary diversions technique consisted of ileal conduits in all cases. Permanent colostomy was performed in all cases. Postoperative complications were related to the urinary diversion in 50% of the cases, to the reconstructive technique in 30%, and to systemic or pelvic infections in 20%.ConclusionsDespite the high morbidity and mortality rates, pelvic exenteration is feasible, and in selected cases of cancer recurrence is the last possible treatment.

Download Full-text