Pelvic Exenteration In Patients Research Articles

Results of pelvic exenteration in patients with cervical cancer: clinical experience

Background. Despite the progress in pelvic exenteration (PE) technique in international oncological practice, it is still debatable for cancer surgeons. The main reasons for its unpopularity are technical complexity, high rate of intra- and postoperative complications (60%), high postoperative mortality (30%), and challenging postoperative rehabilitation of patients.
 Aim. To evaluate long-term outcomes after pelvic exenteration in patients with locally advanced recurrent cervical cancer.
 Materials and methods. From September 2021 to December 2022, 23 PEs were performed, including 12 total and 11 anterior. The mean age was 52.2±10.0 years (range 39–83 years). All patients were diagnosed with locally advanced recurrent cervical cancer: 7 (30%) with stage II, 8 (35%) with stage III, and 8 (35%) with stage IV according to the TNM classification. Histologically, cervical cancer was represented by moderately differentiated squamous cell carcinoma. PE was preceded by the following treatments: neoadjuvant chemotherapy in 17 (74%) patients, surgical treatment in 4 (17%) patients, and chemoradiotherapy in 2 (9%) patients. More than half (56%) of patients achieved grade 2 therapeutic pathomorphism. The advanced disease involved the following adjacent organs: bladder (16; 70%), intestines (13; 56%), uterine endometrium (7; 30%), myometrium and parametrium (4; 17%), fallopian tubes, vagina, and ovary (2; 9%).
 Results. The average follow-up time for patients was 9.4±8.8 months. Median time to progression – 8.7 months [5.9; 10.8]. During the observation period, 78.3% (18/23) of patients died. Progression was recorded in 39.1% (9/23) of patients. The 1-year overall survival of patients was 38.7% (median 8.9 months). The 1-year tumor-specific survival rate was 60.6% (median 14.1 months). The 1- and 3-year progression-free survival (PFS) rates were 63.0 and 49.0% (median, 13.4 months), respectively.
 Conclusion. During the observation period, death occurred in 54.6% (12/23) of cases in the anterior PE group, and in 25% (6/23) in the total group. The median overall survival with anterior PE is 2 times higher compared to total PE (9.6 months versus 4.1 months). Median PFS was 13.4 months. For patients after anterior and total pelvic exenteration, 1-year PFS was 51.9±17.6 and 72.9±13.5; 3-year – 25.9±15.7 and 72.9±13.5 (p=0.178), respectively. Thus, PE is justified and significantly expands the possibilities of surgical treatment.

Assessment of Salvage Surgery in Persistent Cervical Cancer after Definitive Radiochemotherapy: A Systematic Review.

Background and Objectives: The standard treatment approach in locally advanced cervical cancer (LACC) is exclusive concurrent chemoradiation therapy (RTCT). The risk of local residual disease after six months from RTCT is about 20-30%. It is directly related to relapse risk and poor survival, such as in patients with recurrent cervical cancer. This systematic review aims to describe studies investigating salvage surgery's role in persistent/recurrent disease in LACC patients who underwent definitive RTCT. Materials and Methods: Studies were eligible for inclusion when patients had LACC with radiologically suspected or histologically confirmed residual disease after definitive RTCT, diagnosed with post-treatment radiological workup or biopsy. Information on complications after salvage surgery and survival outcomes had to be reported. The methodological quality of the articles was independently assessed by two researchers with the Newcastle-Ottawa scale. Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched the PubMed, Scopus, Cochrane, Medline, and Medscape databases in May 2022. We applied no language or geographical restrictions but considered only English studies. We included studies containing data about postoperative complications and survival outcomes. Results: Eleven studies fulfilled the inclusion criteria and all were retrospective observational studies. A total of 601 patients were analyzed concerning the salvage surgery in LACC patients for persistent/recurrent disease after RTCT treatment. Overall, 369 (61.4%) and 232 (38.6%) patients underwent a salvage hysterectomy (extrafascial or radical) and pelvic exenteration (anterior, posterior, or total), respectively. Four hundred and thirty-nine (73%) patients had histologically confirmed the residual disease in the salvage surgical specimen, and 109 patients had positive margins (overall range 0-43% of the patients). The risk of severe (grade ≥ 3) postoperative complications after salvage surgery is 29.8% (range 5-57.5%). After a median follow-up of 38 months, the overall RR was about 32% with an overall death rate of 40% after hysterectomy or pelvic exenteration with or without lymphadenectomy. Conclusions: There is heterogeneity between the studies both in their design and results, therefore the effect of salvage surgery on survival and recurrence cannot be adequately estimated. Future homogeneous studies with an appropriately selected population are needed to analyze the safety and efficacy of salvage hysterectomy or pelvic exenteration in patients with residual tumors after definitive RTCT.

Minimally invasive versus open pelvic exenteration in gynecological malignancies: a propensity-matched survival analysis

ObjectiveThe primary endpoint of this study was to compare the disease-free survival of patients undergoing open versus minimally invasive pelvic exenteration. The secondary endpoints were cancer-specific survival and peri-operative morbidity.MethodsA...

Fascial space priority approach for laparoscopic total pelvic exenteration in patients with locally advanced rectal cancer.

Total pelvic exenteration (TPE) with intent to achieve a pathological R0 resection is now considered as the only chance of a long-term survival for locally advanced rectal cancer (LARC) invading into adjacent organs. Lately, laparoscopic total pelvic exenteration (LTPE) is performed and achieved in several specialized centers and showed a promising application prospect. Although this is universally realized by surgeons, there are only few specialized centers to perform this complex surgery, due to concerns about the high morbidity and mortality. The techniques associated need to be disclosed and facilitated. The aim of this article is to introduce a fascial space priority approach for laparoscopic TPE step by step (with video). We describe here a fascial space priority approach for LTPE in highly selected patients with locally advanced rectal cancer. The main principle of this approach is that all of the pelvic organs are considered as a whole, the non-vascular spaces surrounding it are separated in the first place, the vascular pedicle and nerve pedicle of pelvic organs can be isolated and then transected precisely. Meanwhile, the associated key landmarks of this approach are disclosed (see the video). The ureterohypogastric nerve fascia (UHGNF) and the vesicohypogastric fascia (VHGF) are two vital embryological planes on the lateral compartment of pelvis. The spaces on either side of them together with the retrorectal space, the space of Retzius, are all non-vascular spaces, and dissection of these spaces in LTPE surgery can be achieved simply and practicably. The ureter, the umbilical artery, the arcus tendinous fasciae pelvis (ATFP), piriformis and the puboprostatic ligament (PPL) are all important landmarks during surgery. Step-by-step illustration with precise anatomical landmarks in the present video may lead to less intraoperative blood loss and complications. LTPE with fascial space priority approach might be a standard surgical procedure for total pelvic exenteration with clear anatomy and reduced blood loss.

Impact of nutritional status and body composition on postoperative outcomes after pelvic exenteration for locally advanced and locally recurrent rectal cancer.

BackgroundPelvic exenteration for locally advanced rectal cancer (LARC) and locally recurrent (LRRC) rectal cancer provides radical resection and local control, but is associated with considerable morbidity. The aim of this study was to determine risk factors, including nutritional status and body composition, for postoperative morbidity and survival after pelvic exenteration in patients with LARC or LRRC.MethodsPatients with LARC or LRRC who underwent total or posterior pelvic exenteration in a tertiary referral centre from 2003 to 2018 were analysed retrospectively. Nutritional status was assessed using the Malnutrition Universal Screening Tool (MUST). Body composition was estimated using standard-of-care preoperative CT of the abdomen. Logistic regression analyses were performed to identify risk factors for complications with a Clavien–Dindo grade of III or higher. Risk factors for impaired overall survival were calculated using Cox proportional hazards analysis.ResultsIn total, 227 patients who underwent total (111) or posterior (116) pelvic exenteration were analysed. Major complications (Clavien–Dindo grade at least III) occurred in 82 patients (36.1 per cent). High risk of malnutrition (MUST score 2 or higher) was the only risk factor for major complications (odds ratio 3.99, 95 per cent c.i. 1.76 to 9.02) in multivariable analysis. Mean follow-up was 44.6 months. LRRC (hazard ratio (HR) 1.61, 95 per cent c.i. 1.04 to 2.48) and lymphovascular invasion (HR 2.20, 1.38 to 3.51) were independent risk factors for impaired overall survival.ConclusionA high risk of malnutrition according to the MUST is a strong risk factor for major complications in patients with LARC or LRRC undergoing exenteration surgery.

Outcomes of metastasectomy and pelvic exenteration for patients with metastatic advanced primary or recurrent rectal cancer.

ANZ Journal of SurgeryVolume 91, Issue 3 p. 231-232 PERSPECTIVE Outcomes of metastasectomy and pelvic exenteration for patients with metastatic advanced primary or recurrent rectal cancer Michelle Z. Chen MBBS (UNSW), MS (USYD), FRACS, Michelle Z. Chen MBBS (UNSW), MS (USYD), FRACS Surgical Outcomes Research Centre, University of Sydney & Sydney Local Health District, Sydney, New South Wales, AustraliaSearch for more papers by this authorKirk K. S. Austin BSc, MB, BCh, BAO, AFRCSI, FRACS, Kirk K. S. Austin BSc, MB, BCh, BAO, AFRCSI, FRACS Surgical Outcomes Research Centre, University of Sydney & Sydney Local Health District, Sydney, New South Wales, Australia Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorMichael J. Solomon MB, BCh, BAO MSc, DMedSc (USYD), DMed (NUI), FRACS, FRCSI, FASCRS, Michael J. Solomon MB, BCh, BAO MSc, DMedSc (USYD), DMed (NUI), FRACS, FRCSI, FASCRS professor.solomon@sydney.edu.au orcid.org/0000-0002-5602-6045 Surgical Outcomes Research Centre, University of Sydney & Sydney Local Health District, Sydney, New South Wales, Australia Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia The Institute of Academic Surgery at RPA, Sydney Local Health District, Sydney, New South Wales, Australia Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, AustraliaSearch for more papers by this authorKilian G. M. Brown BBiomed, MBBS, MPhil, Kilian G. M. Brown BBiomed, MBBS, MPhil Surgical Outcomes Research Centre, University of Sydney & Sydney Local Health District, Sydney, New South Wales, Australia The Institute of Academic Surgery at RPA, Sydney Local Health District, Sydney, New South Wales, AustraliaSearch for more papers by this authorDaniel Steffens BPhty (Hons), PhD, Daniel Steffens BPhty (Hons), PhD orcid.org/0000-0002-9715-860X Surgical Outcomes Research Centre, University of Sydney & Sydney Local Health District, Sydney, New South Wales, Australia The Institute of Academic Surgery at RPA, Sydney Local Health District, Sydney, New South Wales, Australia Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, AustraliaSearch for more papers by this author Michelle Z. Chen MBBS (UNSW), MS (USYD), FRACS, Michelle Z. Chen MBBS (UNSW), MS (USYD), FRACS Surgical Outcomes Research Centre, University of Sydney & Sydney Local Health District, Sydney, New South Wales, AustraliaSearch for more papers by this authorKirk K. S. Austin BSc, MB, BCh, BAO, AFRCSI, FRACS, Kirk K. S. Austin BSc, MB, BCh, BAO, AFRCSI, FRACS Surgical Outcomes Research Centre, University of Sydney & Sydney Local Health District, Sydney, New South Wales, Australia Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorMichael J. Solomon MB, BCh, BAO MSc, DMedSc (USYD), DMed (NUI), FRACS, FRCSI, FASCRS, Michael J. Solomon MB, BCh, BAO MSc, DMedSc (USYD), DMed (NUI), FRACS, FRCSI, FASCRS professor.solomon@sydney.edu.au orcid.org/0000-0002-5602-6045 Surgical Outcomes Research Centre, University of Sydney & Sydney Local Health District, Sydney, New South Wales, Australia Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia The Institute of Academic Surgery at RPA, Sydney Local Health District, Sydney, New South Wales, Australia Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, AustraliaSearch for more papers by this authorKilian G. M. Brown BBiomed, MBBS, MPhil, Kilian G. M. Brown BBiomed, MBBS, MPhil Surgical Outcomes Research Centre, University of Sydney & Sydney Local Health District, Sydney, New South Wales, Australia The Institute of Academic Surgery at RPA, Sydney Local Health District, Sydney, New South Wales, AustraliaSearch for more papers by this authorDaniel Steffens BPhty (Hons), PhD, Daniel Steffens BPhty (Hons), PhD orcid.org/0000-0002-9715-860X Surgical Outcomes Research Centre, University of Sydney & Sydney Local Health District, Sydney, New South Wales, Australia The Institute of Academic Surgery at RPA, Sydney Local Health District, Sydney, New South Wales, Australia Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, AustraliaSearch for more papers by this author First published: 19 March 2021 https://doi.org/10.1111/ans.16294Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume91, Issue3March 2021Pages 231-232 RelatedInformation

Pelvic Exenteration in Patients with Persistent and Recurrent Cervical Cancer: A Case Series from Belarus

ABSTRACT Introduction: The prognosis of patients with persistent or recurrent cervical cancer (CC) is poor, and patient selection for exenterative surgery is challenging. The aim of this study was to determine the outcomes of patients undergoing pelvic exenteration (PE) for persistent or recurrent CC after treatment with radiotherapy in Belarus. Methods: A retrospective study was performed of 22 patients with persistent and recurrent CC who underwent supralevator PE from 2006 to 2012 at NN Alexandrov National Cancer Centre. Anterior PE was performed in 16 (72.7%) patients, posterior PE in 2 (9.1%) and total PE in 4 (18.2%) patients. Results: The mean surgical procedure time was 289.1 minutes. Urinary diversion was performed in 20 patients: 5 (25.0%) underwent ureterostomy and 15 (75.0%) underwent neobladder formation. Fecal diversion with end colostomy (Hartman’s procedure) was performed in 5 patients and in one patient a rectosigmoid resection with anastomosis was performed. The median follow-up time was 87 months (range, 4.4–146.0 months). To date, 16 (72.7%) patients have died of cervical cancer and there were no deaths due to other causes. The median survival was 17 months with a 5-year survival rate of 31.8% (SE 9.9%). Cox regression analysis showed that surgical margin status and pelvic lymph node involvement were independent risk factors for survival. Conclusions: PE was found to be a safe and feasible option for patients with persistent or recurrent cervical cancer who do not have other potentially curative treatment options. Careful patient selection is needed to determine which patients will benefit from this treatment. Highlights:

ASO Author Reflections: Pelvic Exenteration for Patients with Primary and Recurrent Pelvic Cancer.

ASO Author Reflections: Pelvic Exenteration for Patients with Primary and Recurrent Pelvic Cancer.

Pelvic Exenterations for Cervical Cancer Recurrences—a Safe Option in Indian Scenario

Cervical cancer is still a major health problem in India with majority of patients presenting with locally advanced stages. Management of local recurrences of cervical cancer after chemoradiation is a challenging task. Pelvic exenteration is a radical surgery with en bloc resection of pelvic organs is an accepted treatment modality for local recurrence of cervical cancer. In a low-resource country like India where alternate treatment modalities like chemotherapy and targeted therapy are unaffordable to these patients, this radical surgery may be the only treatment modality which gives long-term survival benefit. The aim of the study is to evaluate the morbidity and survival outcome following pelvic exenteration in patients with recurrent cervical cancer in our institution. After obtaining institutional review board approval, a retrospective audit was conducted of all patients who underwent pelvic exenterative surgery for recurrent cervical cancer in our institution from January 2007 to December 2017. The parameters assessed were age of the patient, histologic type and grade, stage of disease, surgical procedures performed, type of reconstruction, intra-operative complications, length of hospital stay, and post-operative morbidity. Patients were followed until March 2017. Survival time was calculated from the date of surgery to the date of last contact or death. Survival estimation was done by Kaplan-Meier method. Between 2007 and 2017, 30 patients underwent the surgery. Mean age of the cohort was 50.9 years (range 33–67 years). Histological type was squamous cell carcinoma in 23 and adenocarcinoma in 7 patients. Twelve patients had anterior exenteration, one had posterior and 17 had total exenteration. The mean operating time was 367.3 min (210–600 min). No post-operative mortality was observed. Post-operative complications were seen in 66.6% of which the most common was of the urinary tract including 4 patients with recurrent urosepsis, one patient with obstructive uropathy and acute renal failure necessitating laparotomy and ureteric reimplantation. Two patients developed fistulae, one urinary and one bowel. Median follow-up time was 27.5 months (1.8–99.1 months). A five-year overall survival for the cohort was 60.5%. It is suggested that pelvic exenteration is an effective technique with reasonable long-term survival benefit and acceptable morbidity in selected patients with cervical cancer recurrence.

Pelvic Exenterations for Advanced and Recurrent Endometrial Cancer: Clinical Outcomes of 40 Patients.

The aim of this study was to analyze the clinical experience and outcome of patients who have undergone pelvic exenteration for primary advanced or recurrent endometrial cancer. We analyzed the medical records of 40 women who underwent pelvic exenteration to treat primary advanced or recurrent endometrial cancer. Pelvic exenteration was performed in 40 patients with primary advanced or recurrent endometrial cancer. Three patients (8%) underwent a primary exenteration, and 37 patients (92%) underwent a secondary exenteration. A total exenteration, anterior exenteration, and posterior exenteration was performed in 85%, 5%, and 10% of patients, respectively.In 31 cases, exenteration was performed with a curative aim, and in 9 cases, exenteration was performed with a palliative aim. The overall survival rates were 61.4% at 5 years and 51.1% at 10 years. For the 31 patients who underwent pelvic exenteration with a curative aim, the overall survival rates were higher than those for the entire study population and were 72.6% at 5 years and 59.4% at 10 years. For the 9 patients who underwent a palliative exenteration, the overall survival rates were 19.1% at 5 years and 0% at 10 years. This is to the best of our knowledge the biggest study of pelvic exenteration in patients with endometrial cancer. Our data show that pelvic exenterations are a valid therapeutic option with long-term survival in select patients.

Pelvic Exenteration for Primary and Recurrent Gynecologic Malignancies Is Safe and Achieves Acceptable Long-Term Outcomes

Abstract Background: Pelvic exenteration can be performed in selected patients with locally advanced primary or recurrent gynecologic malignancies. However, data on long-term outcomes are scarce. Objective: The aim of this study was to describe the current authors' experience of performing pelvic exenteration in patients with locally advanced primary and recurrent gynecologic malignancies. Materials and Methods: A retrospective study of all patients who underwent pelvic exenterations for gynecologic malignancies from January 1982 to June 2011 was performed. Results: Fifty-nine females (mean age: 54; standard deviation: 13.5 years), underwent pelvic exenteration (24 [40.7%] total, 35 [59.3%] near total) for advanced gynecologic malignancies. Ovarian and cervical cancers were most frequently seen in 27 (45.8%) and 17 (28.8%) patients, respectively. Although there was no inpatient mortality, 26 (44%) patients developed perioperative complications. Urologic complications occurred in 10 (17%) patients. One pat...

Initial experience of robotic anterior pelvic exenteration at a single institute

ObjectiveTo present the initial experience with robotic anterior pelvic exenteration in patients with advanced pelvic cancer at Galaxy Care Laparoscopy Institute, Pune, India. MethodsA retrospective chart review of data from 10 patients with advanced cervical carcinoma and bladder involvement or with vault recurrence following hysterectomy who were treated at the study hospital between November 2009 and May 2011. Clinicopathologic data and postoperative data including operative time, blood loss, blood transfusions, hospital stay, lymph node yield, and complications were recorded. ResultsThe mean operative time was 180minutes, the mean blood loss was 110mL, and the mean duration of hospital stay was 5days. There were no treatment-related morbidities or mortalities. A mean parametrial clearance of 3cm with a distal vaginal margin of 3.5cm was achieved. All patients had tumor-free margins. The mean number of harvested lymph nodes was 24. Six patients had positive lymph nodes on pathologic examination and were treated with chemoradiotherapy. At a median follow-up of 11months, 8 patients were disease-free. ConclusionRobot-assisted anterior pelvic exenteration had favorable operative, pathologic, and short-term clinical outcomes. A large multicenter study is required to confirm the results.

Pelvic exenteration in patients with nonmetastatic, locally advanced castration-resistant prostate cancer.

168 Background: A subset of patients who present with localized prostate cancer (PCa) do not develop metastatic disease and recur locally after definitive primary therapy, local salvage therapy, hormones, and systemic intervention. We report our experience in patients with non-metastatic, locally advanced castration resistant prostate cancer (CRPC) treated with radical cystectomy or pelvic exenteration (RC/PEx). Methods: Institutional review board (IRB) approved retrospective review of all patients undergoing RC/PEx for non-metastatic, locally recurrent CRPC after definitive and salvage therapies. Patients were excluded if RC/PEx was for complications of definitive therapy alone. Results: Of 31 patients who had RC/PEx for PCa, 20 met inclusion criteria. Initial therapy was RP (4), XRT (6), brachytherapy (4), brachy/XRT (3), ADT/chemo (2), and ADT alone (1). Five patients had salvage XRT. All received ADT at relapse and 11 had chemotherapy prior to RC/PEx. RC/PEx was performed a median of 8.16 years (0.7 to 24.5) after PCa diagnosis. Patients had pT2b (1), pT3 (5), and pT4 (14) disease at surgery. Lymph nodes were clinically negative in all patients but pathologically positive in six, negative in nine, and not resected in five. Concurrent resections included rectum (12), pelvic wall (6), pubis (1), and iliac vein (1). Eighty five percent of patients had symptoms attributable to locally progressive PCa at RC/PEx including pain, genitourinary or gastrointestinal obstruction and bleeding. All symptomatic patients had relief of disease-related symptoms until recurrence. After a median follow-up of 3.12 years (0.7 to 13.4), nine patients are alive (four have no evidence of disease, five alive with disease), nine dead of disease, and two dead of other causes. Median time to death after RC/PEx was 2.8 years (0.8 to 5.9). For 14 patients who relapsed, metastases developed a median of 398 days (110 to 1,679) after RC/PEx. Ten patients received chemotherapy and 16 had androgen-deprivation therapy after surgery for local recurrence or distant metastases. Median time to chemotherapy after RC/PEx was 346 days (96 to 1,709). Conclusions: For patients with non-metastatic, locally advanced CRPC, RC/PEx to resect symptomatic disease is feasible and appears clinically beneficial. In addition to local control, it may confer significant disease free intervals and relief of symptoms. Even after relapse, performance status was sufficient to undergo systemic therapy.

First report: robotic pelvic exenteration for locally advanced rectal cancer

The aim of this study was to present the feasibility and surgical outcome of robotic en bloc resection of the rectum and with prostate and seminal vesicle invaded by rectal cancer. The details of three consecutive cases involving male patients in their forties, with locally invasive low rectal cancers are presented. The da Vinci robotic system was used by experienced colorectal and urological surgeons to perform en bloc resection of the rectum, prostate and seminal vesicles. In the first case, coloanal and vesico-urethral anastomoses were performed, and the second included an end colostomy and vesico-urethral anastomosis. The bladder and bulbar urethra were also removed en bloc in the third case, with robotic intracorporeal ileal conduit formation and end colostomy. There was no major complication postoperatively. In the second patient there was a minor leakage at the vesico-urethral anastomosis. The third was readmitted the following week with a urinary infection which settled with intravenous antibiotics. In the first case, the circumferential resection margin was microscopically positive but the patient is currently free of recurrence after 14months. In the second and third cases, all margins were clear. This the first report of the use of the da Vinci robotic system for pelvic exenteration in patients with locally advanced rectal cancer invading the prostate and seminal vesicles. The robot may have a potential role in selected patients requiring exenterative pelvic surgery particularly in men.

Pelvic exenteration for recurrent squamous cell carcinoma of the pelvic organs arising from the cloaca – a single institution's experience over 16 years

Minimal data are available on the role of pelvic exenteration in patients with recurrent squamous cell carcinoma (SCC) of the pelvic organs. This study aimed to highlight our experience of pelvic exenteration in patients with recurrent and re-recurrent SCC of the pelvic organs. A retrospective review of all patients who underwent pelvic exenteration for recurrent SCC of the pelvic organs arising from the embryological cloaca from 1994 to 2010 was performed. Twenty-four patients (median age 59, range, 27-79 years) underwent pelvic exenteration for recurrent SCC of the anus (18), cervix and upper vagina (2), lower vagina (1) and the vulva (3). Nine patients with anal SCC had undergone abdominoperineal excision prior to pelvic exenteration. Ten (41.7%) patients underwent a complete pelvic exenteration procedure, while sacrectomy was performed in 13 (54.2%) patients. There was no 30-day inpatient mortality. An R0 resection was achieved in 15 (62.5%) patients. Three (12.5%) had R1 resections while 6 (25%) had R2 resections. In the 15 patients with an R0 resection, 7 (46.7%) developed metastatic disease at a median of 18 (range 10-131) months. After a median follow-up of 26 (range 4-169) months, 1- and 2-year overall survival rates were 64% [95% confidence interval (CI), 44-84%] and 57% (95% CI 35-79%), respectively. Pelvic exenteration for recurrent SCC of the cloaca is safe and feasible even after previous salvage surgery. An R0 resection can be achieved in 62.5% of the patients with reasonable early survival though less than published recurrent rectal cancer studies.

Neoadjuvant chemotherapy prior to pelvic exenteration in patients with recurrent cervical cancer: Single institution experience

ObjectivesThe aim of the study is to evaluate the response to neoadjuvant chemotherapy (NACHT) of patients with recurrent cervical cancer who were poor candidates for pelvic exenteration (PE), and the impact on DFS and OS. MethodsA retrospective data collection extracted from medical records of 61 patients submitted to pelvic exenteration was performed: 30 underwent up-front exenterative procedure whereas 31 received NACHT. ResultsThe median tumor size was significantly (P=0.0006) larger in the NACHT group compared to the up-front PE one (43.9mm vs 28mm), and a significant (P=0.04) higher percentage of patients (45 vs 20%) had lateral pelvic wall invasion in the NACHT group. No statistically significant difference in early and late complications was observed in the two groups. Median overall survival in study population was 42.9months (95% CI: 22.2, 180.8). Median overall survival times as well as recurrence free survival times were not significantly different between NACHT (42.9months and 36.1months for OS and DFS respectively) vs. No NACHT (111.9months and 48.1months for OS and DFS respectively). There was an overall significant difference in DFS between negative and positive margins but the curves were similar for NACHT and up-front PE groups stratified by resection margin status. ConclusionsIn our series, though small and retrospective, NACHT prior to PE represents a feasible therapeutic option without intra-operative and early post-operative mortality or worsening of early and late complication rate and with acceptable long-term survival and DFS for recurrent cervical cancer patients who are poor candidates for up-front pelvic exenteration.

Clinical outcome of pelvic exenteration in patients with advanced or recurrent uterine cervical cancer

Pelvic exenteration has attained an important role in the treatment of advanced or recurrent cervical cancer for obtaining a complete cure or longer disease-free survival. The purpose of this study was to evaluate patients undergoing pelvic exenteration and to determine the clinical features associated with outcome and survival. We retrospectively analyzed the records of 12 patients who underwent pelvic exenteration for uterine cervical cancer between July 2002 and August 2011. Two patients had primary stage IVA cervical adenocarcinoma and 10 patients had recurrent cervical cancer. Eight patients underwent anterior pelvic exenteration, 3 patients underwent total pelvic exenteration, and 1 patient underwent posterior pelvic exenteration. With a median duration of follow-up of 22 months (range 3-116 months), 5 patients were alive without recurrence. Of 5 patients with no evidence of disease, 4 were recurrent or residual tumor, all of whom had common factors, such as a tumor size ≤ 30 mm, negative surgical margins, complete resection, and no lymph node involvement. The 5-year overall survival rate for 12 patients was 42.2 %. Ileus was the most common complication (42 %) and post-operative intestinal anastomosis leaks developed in 3 patients, but no ureteral anastomosis leaks occurred. Pelvic exenteration is a feasible surgical procedure in advanced and/or recurrent cervical cancer patients with no associated post-operative mortality, and the only therapeutic option for complete cure or long-term survival; however, post-operative complications frequently occur.

Neoadjuvant chemotherapy prior to pelvic exenteration in patients with recurrent cervical cancer: Single institution experience

Neoadjuvant chemotherapy prior to pelvic exenteration in patients with recurrent cervical cancer: Single institution experience

Single Port Access (SPA) Robot Assisted Laparoscopic Surgery for Posterior Pelvic Exenteration in Patients with Advanced Ovarian Cancer: Farghaly's Technique

Single Port Access (SPA) Robot Assisted Laparoscopic Surgery for Posterior Pelvic Exenteration in Patients with Advanced Ovarian Cancer: Farghaly's Technique

MRI at the completion of chemoradiotherapy can accurately evaluate the extent of disease in women with advanced urethral carcinoma undergoing anterior pelvic exenteration

To demonstrate the value of pelvic magnetic resonance imaging (MRI) in mapping tumour extension after chemoradiotherapy and before anterior pelvic exenteration in patients with primary carcinoma of the urethra. The Institutional Review Board approved and issued a waiver of informed consent for this retrospective study, which was compliant with the Health Insurance Portability and Accountability Act. Six women (median age 51 years, range 39-63 years) with histopathology-proven urethral carcinoma who underwent neoadjuvant chemoradiotherapy before anterior pelvic exenteration were included in the study. All had MRI performed at first presentation and after completion of chemoradiotherapy. MRI images were analysed by an experienced reader, who was blinded to the clinical data. The tumour location, signal intensity, size, local extension, and presence of enlarged lymph nodes were recorded for each patient at baseline and after chemoradiotherapy. Surgical histopathology constituted the reference standard. All tumours were locally advanced (stage T3) at baseline MRI. The mean maximum diameter of the tumour at baseline MRI was 3.7 cm (range 2.4-5 cm). After chemoradiotherapy, the mean reduction in maximum tumour diameter on MRI was 44% (range 13-67%), but only three cases were down-staged. MRI was accurate in the evaluation of tumour extension after completion of chemoradiotherapy in all cases. Persistence of bladder neck and anterior vaginal wall invasion was correctly identified in three cases. In women with advanced primary urethral cancer, MRI is an excellent tool for monitoring neo-adjuvant chemoradiotherapy changes and evaluating the extent of disease before exenterative surgery.