Extended pelvic resection of iliacus muscle and femoral nerve for isolated recurrent uterine cancer

Abstract

Tumor persistence or local recurrence in an irradiated pelvis indicates a dismal prognosis. Until now, salvage was only possible in selected patients with central disease who had undergone pelvic exenteration. Patients with a pelvic sidewall component, representing the most common situation of local failure, are traditionally considered ineligible for curative therapy. Pelvic sidewall involvement, suggested by the clinical triad of hydronephrosis, leg edema and sciatic nerve pain, has been considered a contraindication to pelvic exenteration [1]. With extended endopelvic resections involving the resection of sidewall muscles and major vessels in the lesser pelvis, Hockel included 24 of his patients with recurrent cervical cancer and found a 5-year disease-free and overall survival of 41% and 44%, respectively [2]. This approach enables those with pelvic sidewall disease a chance at cure, with an acceptable associated morbidity. The scope of pelvic exenteration is changing. Advances in imaging enable us to select more appropriate surgical candidates, and the definition of a radical surgical resection has expanded, allowing us to offer pelvic exenteration to patients previously deemed inoperable. Resection of nerve, muscle, and bone has been incorporated in an attempt to obtain curative resections. The objective of this review is to illustrate the techniques utilized in resection of pelvic bone, sidewall muscle, and major nerves in those undergoing surgery for recurrent gynecologic malignancies. We hope that these