Exenteraţia pelviană – între istorie şi viitor

Abstract

Introduction. Advanced pelvic neoplasms are often real trials for oncologists, radiation therapists and onco­lo­gi­cal surgeons. The treatment must be individualized for each patient and it sometimes involves extensive exen­te­ra­tive interventions burdened with significant mor­bi­di­ty. Although known for more than 80 years, pelvic exen­te­ra­tions have undergone countless technical changes over time which led to a decrease in mortality and to improved sur­vi­val and quality of life parameters. Materials and me­thod. In this paper, we aim to carry out a review of the in­ter­na­tio­nal publications dedicated to pelvic exen­te­ra­tions, following the changes undergone by the sur­gi­cal tech­nique and their impact on survival, morbidity as­so­cia­ted with the method and on perioperative mortality. Re­sults. The advances in surgical techniques allowed the ex­ten­sion of the resection in three compartments: pos­te­rior (through resection of the sacrum), lateral (through ex­ten­ded muscle resections, iliac vessel resections followed by va­­rious reconstructive techniques, nerve resections) and an­­te­­rior (through pubic or perineal urethra resections). The de­­ve­lop­­ment of urinary-genital reconstruction techniques also contributed to the improvement of the patients’ qua­li­ty of life. Restoring the pelvic floor by using the grea­ter omentum or other materials like breast implants, bio­­de­­gra­­dable meshes, dura mater or bladder peritoneum cau­ses a decrease in the complications associated with the “empty pelvis syndrome”, responsible for the majority of post-pelvectomy morbidity. Finally, minimally invasive and ro­bo­tic techniques cause a decrease in intraoperative blood loss and duration of hospitalization, at the cost of a longer du­ra­tion of the intervention. Con­clu­sions. The pel­vec­to­my, an operation with a long his­to­ry, in continuous re­in­ven­tion and upgrading, still plays an im­por­tant role in the therapy of advanced primary or re­cur­rent pelvic can­cers, being some­times the only the­ra­peu­tic method that can increase sur­vi­val. However, it re­quires a good selection of patients and must be performed in a spe­cia­lized center in or­der to achieve the best results and to avoid complications.