Pelvic Resection Research Articles

MP53-17 IS PREOPERATIVE BIOPSY AND BONE CULTURE NECESSARY BEFORE SURGERY FOR PUBIC OSTEOMYELITIS CAUSED BY THE URINARY SYSTEM?

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (MP53)1 Sep 2021MP53-17 IS PREOPERATIVE BIOPSY AND BONE CULTURE NECESSARY BEFORE SURGERY FOR PUBIC OSTEOMYELITIS CAUSED BY THE URINARY SYSTEM? Anessa Sax-Bolder, Eseosa Enabulele, Jason Stoneback, and Ty Higuchi Anessa Sax-BolderAnessa Sax-Bolder More articles by this author , Eseosa EnabuleleEseosa Enabulele More articles by this author , Jason StonebackJason Stoneback More articles by this author , and Ty HiguchiTy Higuchi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002083.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pubic osteomyelitis (PO) is a rare and devastating diagnosis. Historically, first line treatment for PO has been antibiotic treatment. More recently, a multidisciplinary surgical approach has been used, including radical cystectomy with ileal conduit and omental flap with simultaneous anterior pelvic resection with intraoperative biopsies. Preoperative CT-guided bone biopsies for pathology and culture data can be helpful in guiding therapy. Herein we report the concordance of pre and intraoperative biopsies in pubic osteomyelitis caused by urinary tract erosion. METHODS: Retrospective chart reviews were completed at a single tertiary academic medical center. Patients that received surgery for PO from 2013-2020 were included. Demographic data, management and outcomes were collected. RESULTS: A total of 17 patients were identified. 10 patients (59%) underwent a preoperative CT-guided biopsy with 50% (5/10) yielding negative bone culture (BC) results. Of the negative BC results, 4 had positive intraoperative BC. The remaining patient had a negative intraoperative BC but did have a positive intraoperative tissue culture. Of the 5 positive preoperative BC, 4 had intraoperative BC that grew organisms not found in the preoperative biopsy. The final patient with a positive preoperative BC had a negative intraoperative BC. Overall, of the 10 patients who underwent preoperative BC, 90% (9/10) had discordance between their preoperative CT-guided BC and their intraoperative BC. No patients had preoperative biopsy showing cancer, yet 24% (4/17) had intraoperative frozen sections showing cancer (prostatic adenocarcinoma, colorectal adenocarcinoma, urothelial cell carcinoma and squamous cell carcinoma). All 4 had a history of radiation for prostate cancer. One recent patient not included in the study had a bone biopsy showing urothelial carcinoma, thus the success rate of bone biopsy in our series is 18% (2/11). CONCLUSIONS: In this review, preoperative BC was not concordant with intraoperative BC. Potential explanations include the limited sample obtained in preoperative BC or subsequent antimicrobial treatment after preoperative BC. This study suggests caution should be used when basing clinical decisions off preoperative BC due to risk of misguiding antimicrobial treatment. Preoperative biopsy for pathology should be performed to rule out malignancy, however in our series this yielded low success rate and intraoperative frozen sections are vital. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e945-e945 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anessa Sax-Bolder More articles by this author Eseosa Enabulele More articles by this author Jason Stoneback More articles by this author Ty Higuchi More articles by this author Expand All Advertisement Loading ...

Malignant Germ cell Tumor of Ovary: An Unusual Combination and An Irony of Fate

Malignant mixed ovarian germ cell tumors are very rare malignant ovarian germ cell tumors, with a very high degree of malignancy. They are aggressive cancers affecting young adolescent girls. The commonest combination reported in literature is dysgerminoma and endodermal sinus tumors. Fertility sparing surgery followed by combination chemotherapy is the treatment of choice. The objectives of this case report are the advanced age of presentation, unusual histopathological combination, and the irony of infertility treatment. We report a rare case of 40-year-old woman with Malignant mixed germ cell tumor comprising of components of endodermal sinus tumor, immature teratoma, dysgerminoma and embryonal carcinoma. Patient was on hormonal therapy for the cause of infertility, presented with complains of lower abdominal pain, constipation and incomplete evacuation of bladder for 2months. Transvaginal ultrasonography and CT scan showed a large multicystic space occupying lesion with predominant solid component in midline abdominopelvic location. Tumor markers i.e., AFP, Prolactin and CA125 were raised. Total abdominal hysterectomy and bilateral salpingoophorectomy, pelvic and retroperitoneal node resection, peritonectomy and omentectomy was performed.

3D-Printed Titanium Custom-Made Prostheses in Reconstruction after Pelvic Tumor Resection: Indications and Results in a Series of 14 Patients at 42 Months of Average Follow-Up.

Wide resection is currently considered the mainstay treatment for primary bone tumors. When the tumor is located in anatomically complex segments, 3D-Printed Titanium Custom-Made Prostheses (3DPTCMP) are possible reconstructive solutions. The aim of the present paper is to analyze indications, results and complications of a series of 14 patients who underwent pelvis reconstruction with 3DPTCMP after tumor removal from January 2015 to December 2019. Chondrosarcoma was the main histology; indications were tumors located in the acetabular area without enough residual bone to support a cup with an iliac stem, and tumors located near the sacrum-iliac joint. The margins were wide in 12 cases, and marginal and intralesional in one case each. In three cases, resection also included the sacrum-iliac joint, so a spine stabilization was performed and linked to the pelvic prosthesis; The average MSTS score was 46.3%; the 5-year local recurrence-free survival was 85.7%. Wound dehiscences were the main complication, resolved with multiple debridements; nevertheless, prosthesis removal was necessary in one case. Currently, the 3DPTCMP is an effective resource for reconstruction after resection of tumors located in the pelvis. Further studies are necessary to value long-term results; more strategies are necessary to try to reduce the infection rate and improve osteointegration.

Computer-Assisted Surgical Navigation for Primary and Metastatic Bone Malignancy of the Pelvis: Current Evidence and Future Directions.

Computer-assisted navigation and robotic surgery have gained popularity in the treatment of pelvic bone malignancies, given the complexity of the bony pelvis, the proximity of numerous vital structures, and the historical challenges of pelvic bone tumor surgery. Initial interest was on enhancing the accuracy in sarcoma resection by improving the quality of surgical margins and decreasing the incidence of local recurrences. Several studies have shown an association between intraoperative navigation and increased incidence of negative margin bone resection, but long-term outcomes of navigation in pelvic bone tumor resection have yet to be established. Historically, mechanical stabilization of pelvic bone metastases has been limited to Harrington-type total hip arthroplasty for disabling periacetabular disease, but more recently, computer-assisted surgery has been employed for minimally invasive percutaneous fixation and stabilization; although still in its incipient stages, this procedure is potentially appealing for treating patients with bone metastases to the pelvis. The authors review the literature on navigation for the treatment of primary and metastatic tumors of the pelvic bone and discuss the best practices and limitations of these techniques.

Clinical study of 3D printed personalized prosthesis in the treatment of bone defect after pelvic tumor resection

Background/Objective: In recent years, prostheses have been widely used for limb reconstruction after pelvic tumour resection. However, prostheses are associated with problems leading to tumour recurrence, poor implant matching, defects after tumour resection, and easy implant looseness or failure. To achieve a precise preoperative design, complete tumour resection, and better anatomical structure matching and prosthesis stability, this study used three-dimensionally (3D)-printed osteotomy guides and personalised prostheses for reconstruction after pelvic tumour resection. This study aimed to explore the early clinical efficacy of 3D printed personalised prostheses for the reconstruction of bone defects after pelvic tumour resection.MethodsA total of 20 patients (12 males, 8 females) with pelvic tumours surgically treated at our hospital between October 2014 and October 2019 were selected. There were 10 cases each of giant cell bone tumours and osteochondrosarcomas. According to Enneking zoning, there were 11 and 9 cases with tumours located in zones I and II, respectively. All cases were equally divided into conventional and 3D printing groups. For repair and reconstruction, a nail rod system or a steel plate was used in the conventional group while individualised 3D-printed prostheses were used in the 3D printing group. The surgical incision, duration of surgery, intraoperative blood loss, and the negative rate of resection margins in postoperative tumour specimens were examined. The follow-up focused on tumour recurrence, complications, and the Musculoskeletal Tumor Society (MSTS) score.ResultsAll cases were followed-up for 6–24 months. The average incision length, duration of surgery, amount of intraoperative blood loss, and MSTS score of the 3D printing group were 10.0 ± 3.1 cm, 115.2 ± 25.3 min, 213.2 ± 104.6 mL, 23.8 ± 1.3, respectively, and those of the conventional group were 19.8 ± 8.4 cm, 156.8 ± 61.4 min, 361.4 ± 164.2 mL, and 18.3 ± 1.4, respectively. Histological tumour specimen examination showed nine and three cases with negative resection margins in the 3D printing group and the conventional group, respectively. The abovementioned indicators were significantly different between both groups (P < 0.05).ConclusionApplying 3D printed surgical guides and personalised prostheses for pelvic tumour resection, repair, and reconstruction, as well as preoperative planning and design, enables more accurate tumour resections and better prosthesis-patient matchings, possibly reducing surgical trauma, shortening the duration of surgery, and promoting the functional recovery of patients postoperatively.The Translation Potential of this ArticleContrary to existing studies on 3D printed personalised prostheses, this study reports the clinical efficacy of the aforementioned technology in treating bone defects in a series of patients who underwent pelvic tumour resection. Moreover, it presents a comprehensive comparison of this technology with conventional procedures, thus strengthening its importance in treatment regimens for reconstructing bone defects.

ASSOCIATION BETWEEN PELVIC EXENTERATION AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY FOR RECTAL CANCER

Colorectal cancer spreads via multiple pathways, the most commonly encountered ways being represented by the peritoneal and hematogenous ones as well as by direct contiguity. At this time significant benefits in terms of survival have been reported in cases presenting locally advanced lesions and for those presenting extended peritoneal lesions of peritoneal carcinomatosis especially if radical resection is achievable. In this respect, certain authors went further and investigated whether the association of the two surgical strategies – extended pelvic resections and cytoreductive surgery of the peritoneal metastases could improve survival in cases in which both patterns of spread are present. Meanwhile, the possibility of association of hyperthermic intraperitoneal chemotherapy (HIPEC) was also investigated. The aim of the current study is to review and analyze the most relevant studies conducted on this issue.

A Short-Course Antibiotic Prophylaxis Is Associated with Limited Antibiotic Resistance Emergence in Post-Operative Infection of Pelvic Primary Bone Tumor Resection.

Resections of primary pelvic bone tumors are frequently complicated by surgical site infections (SSIs), thereby impairing the functional prognosis of patients, especially in case of implant removal. Although prophylactic antibiotics play an essential role in preventing SSIs, there are presently no recommendations that support their appropriate use. This study aimed to assess the impact of a 24 h prophylactic protocol on the bacterial ecology, the resistance pattern, and the SSI healing rate. We hypothesized that this protocol not only limits the emergence of resistance but also results in a good cure rate with implant retention in case of SSI. A retrospective study was performed that included all patients with an SSI following a pelvic bone tumoral resection between 2005 and 2017 who received a 24 h antibiotic prophylaxis protocol. Twenty-nine patients with an SSI were included. We observed a 75.9% rate of polymicrobial infection, with a high prevalence of digestive flora microorganisms and a majority of wild-type phenotypes. We confirmed that there was no significant emergence of resistant flora. After first-line debridement, antibiotics (DA) if any implant was used, or debridement, antibiotics, and implant retention (DAIR) whenever possible, we obtained a 79.3% cure rate, with implant removal in 20% of cases. The absence of an implant was significantly associated with SSI healing. Early infection management and low resistance profiles may also have a positive effect, but this needs to be confirmed in a larger cohort. In light of this, the use of a 24 h prophylactic protocol in primary pelvic bone tumor resections is associated with a favorable infection cure rate and implant retention in case of SSI, and minimal selection of resistant microorganisms.

Laparoscopic Uterine Artery Occlusion Combined with Uterine-sparing Pelvic Plexus Block and Partial Adenomyomectomy for Adenomyosis: A Video Case Report

OBJECTIVE Adenomyosis usually causes dysmenorrhea and anemia. Clinically, it is difficult to be solved by medicine and traditional surgery, and hysterectomy is always performed for radical treatment. In this article, we introduce a new method which could control the dysmenorrhea and anemia through laparoscopic uterine artery occlusion (LUAO) combined with uterine-sparing pelvic plexus block, and partial adenomyomectomy for uterus perservation.

The Orthopedic-Vascular Multidisciplinary Approach Improves Patient Safety in Surgery for Musculoskeletal Tumors: A Large-Volume Center Experience.

Objective: Wide-margin resection is mandatory for malignant bone and soft tissue tumors. However, this increases the complexity of resections, especially when vessels are involved. Patients in this high-risk clinical setting could be surgically treated using the multidisciplinary orthopedic-vascular approach. This study was carried out in this healthcare organization to evaluate patient safety in term of oncologic outcomes and reduction of the complication rate. Materials and Methods: We retrospectively reviewed 74 patients (37 males, 37 females; mean age 46 years, range 9–88) who underwent surgical excision for bone/soft tissue malignant tumors closely attached to vascular structures from October 2015 to February 2019. Vascular surgery consisted of isolation of at least one vessel (64 patients), bypass reconstruction (9 patients), and end-to-end anastomosis (1 patient). Mean follow-up was 27 months. Patients’ demographics, tumor characteristics, adjuvant treatments, type of orthopedic and vascular procedures, and oncologic and functional outcomes and complications were recorded. Results: Overall survival was 85% at 3 years follow-up. In total, 22 patients experienced at least one major complication requiring further surgery and 13 patients experienced at least one minor complication, whereas 17 reported deviations from the normal postoperative course without the need for pharmacological or interventional treatment. Major complications were higher in pelvic resections compared to limb-salvage procedures (p = 0.0564) and when surgical time was more than 4 h (p = 0.0364) at univariate analysis, whereas the most important multivariate independent predictors for major complications were pelvic resection (p = 0.0196) and preoperative radiotherapy (p = 0.0426). Conclusions: A multidisciplinary ortho-vascular approach for resection of malignant bone and soft tissue tumors tightly attached to important vascular structures should be considered a good clinical practice for patient safety.

Impact of the preoperative prognostic nutritional index as a predictor for postoperative complications after resection of locally recurrent rectal cancer

BackgroundLocal recurrence is common after curative resections for rectal cancer. Surgical intervention is among the best treatment choices. However, achieving a negative resection margin often requires extensive pelvic organ resections; thus, the postoperative complication rate is quite high. Recent studies have reported that the inflammatory index could predict postoperative complications. This study aimed to validate the correlation between clinical factors, including inflammatory markers, and severe complications after surgery for local recurrent rectal cancer.MethodsThis retrospective study included 99 patients that underwent radical resections for local recurrences of rectal cancer. Postoperative complications were graded according to the Clavien-Dindo classification. Grades ≥3 were defined as severe complications. Risk factors for severe complications were identified with univariate and multivariate logistic regression models and assessed with receiver-operating characteristic curves.ResultsSevere postoperative complications occurred in 38 patients (38.4%). Analyses of correlations between inflammatory markers and severe postoperative complications revealed that the strongest correlation was found between the prognostic nutrition index and severe postoperative complications. The receiver-operating characteristic analysis showed that the optimal prognostic nutrition index cut-off value was 42.2 (sensitivity: 0.790, specificity: 0.508). In univariate and multivariate analyses, a prognostic nutrition index ≤44.2 (Odds ratio: 3.007, 95%CI:1.171–8.255, p = 0.02) and a blood loss ≥2850 mL (Odds ratio: 2.545, 95%CI: 1.044–6.367, p = 0.04) were associated with a significantly higher incidence of severe postoperative complications.ConclusionsWe found that a low preoperative prognostic nutrition index and excessive intraoperative blood loss were risk factors for severe complications after surgery for local recurrent rectal cancer.

Tricky Diagnosis and Robot-laparoscopic Surgical Approach to Disseminated Peritoneal Leiomyomatosis

To show the challenging diagnosis of, and safe robotic surgical approach to, a rare case of disseminated peritoneal leiomyomatosis (DPL). A clinical case shown by a sequential demonstration of investigation, diagnosis, and surgical approach, with narrated video footage. DPL is a rare disease, with only a little more than 150 cases reported in the literature [1]. It is defined by subperitoneal proliferation of benign smooth muscle cell nodules, macroscopically mimicking peritoneal carcinomatosis [2]. The etiology remains unclear, but different hypotheses have been put forward, such as subperitoneal mesenchymal stem cell metaplasia and iatrogenic origin after myomectomy [3]. Despite its usual benign behavior, DPL can rarely present with malignant degeneration, and therefore a complete resection of multiple lesions is recommended [4]. This case involves a 45-year-old patient presenting with dysmenorrhea, abdominal pain, and major abnormal uterine bleeding, requiring previous blood transfusion and no response after 2 years of clinical treatment. She had a previous cesarean delivery, with no reproductive desire at present and no history of other pelvic surgeries. Pelvic examination showed an enlarged mobile uterus at the height of the pubic symphysis, and both ultrasonography and magnetic resonance imaging confirmed an enlarged uterus due to multiple myomas. (1) Diagnostic laparoscopy with implant biopsies and uterine curettage for investigation of DPL and its differential diagnoses, followed by robot-assisted laparoscopic approach, with key strategies for a safe performance. (2) Radical hysterectomy with bilateral salpingo-oophorectomy, omentectomy, and wide pelvic peritoneal resection were performed. (3) For this complex procedure, the identification and preservation of important landmarks and pelvic anatomy were mandatory, as well as removal of all surgical specimens in monobloc. Final pathology report: disseminated leiomyomatosis with no evidence of malignancy. The patient had no complications after surgery and was discharged on the second postoperative day with mild abdominal pain. DPL diagnosis can be tricky owing to its macroscopic similarity to peritoneal carcinomatosis and the difficulty of identification in imaging examinations. Moreover, the robotic platform can be a helpful and safe tool for the surgical treatment of DPL and complete resection of all peritoneal lesions.

Hospital volume is associated with cost and outcomes variation in 2,942 pelvic reconstructions

Complex pelvic reconstruction is challenging for plastic and reconstructive surgeons following surgical resection of the lower gastrointestinal or genitourinary tract. Complication rates and hospital costs are variable and may be linked to the hospital case volume of pelvic reconstructions performed. A comprehensive examination of these factors has yet to be performed. Data were retrieved for patients undergoing pedicled flap reconstruction after pelvic resections in the American National Inpatient Sample database between 2010 and 2014. Patients were then separated into three groups based on hospital case volume for pelvic reconstruction. Multivariate logistic regression and gamma regression with log-link function were used to analyze associations between hospital case volume, surgical outcomes, and cost. In total, 2,942 patients underwent pelvic flap reconstruction with surgical complications occurring in 1,466 patients (49.8%). Total median cost was $38,469.40. Pelvic reconstructions performed at high-volume hospitals were significantly associated with fewer surgical complications (low: 51.4%, medium: 52.8%, high: 34.8%; p<0.001) and increased costs (low: $35,645.14, medium: $38,714.92, high: $44,967.29; p<0.001). After regression adjustment, high hospital volume was the strongest independently associated factor for decreased surgical complications (Exp[β], 0.454; 95% Confidence Interval, 0.346-0.596; p<0.001) and increased hospital cost (Exp[β], 1.351; 95% Confidence Interval, 1.285-1.421; p<0.001). Patients undergoing pelvic flap reconstruction after oncologic resections experience high complication rates. High case volume hospitals were independently associated with significantly fewer surgical complications but increased hospital costs. Reconstructive surgeons may approach these challenging patients with greater awareness of these associations to improve outcomes and address cost drivers.

The combined use of pedicled profunda artery perforator and bilateral gracilis flaps for pelvic reconstruction: A cohort study

The result of an extra-levator abdominoperineal excisionof the rectum (ELAPE) is a composite three-dimensional defect. This is performed for locally advanced anorectal cancer, and may involve partial excision of the vagina. The aim of reconstruction is to achieve wound healing, restore the pelvic floor and to allow micturition and sexual function. We aim to evaluate the concurrent use of profunda artery perforator (PAP) and bilateral gracilis flaps for vaginal and pelvic floor reconstruction. We performed a retrospective case note review of patients undergoing pelvo-perineal reconstruction with combined gracilis and PAP flaps between July 2018 and December 2019. Eighteen pedicled flaps were performed on six patients with anal or vulval malignancies. All underwent pre-operative radiotherapy. Four patients had extended abdominoperineal tumour resections, while two patients underwent total pelvic exenteration. The median age was 57 (range 47-74) years, inpatient stay was 22 (11-47) days and the follow-up was 10 (5-21) months. Four patients developed partial perineal wound dehiscence, of which one was re-sutured. One patient had a post-operative bleed requiring radiological embolisation of an internal iliac branch and had subsequent 1cm PAP flap loss. All other flaps survived completely. Median time to heal was 4 (1-6) months. This is the first series reporting combined bilateral gracilis and PAP flaps for pelvic reconstruction. The wound dehiscence rate and healing times were expected in the context of irradiation and radical pelvic tumour resection. This is a reliable technique for perineal and vaginal reconstruction with minimal donor site morbidity.

First report on establishment and characterization of a carcinosarcoma tumour cell line model of the bladder

Carcinosarcoma of the urinary bladder is a very rare and aggressive subtype of bladder cancer with poor prognosis. Characteristically carcinosarcomas exhibit biphasic nature with both epithelial and mesenchymal differentiation. Limited information is available regarding its clinical features and appropriate treatments due to its rarity. Development of tumour models can further our understanding of bladder carcinosarcoma. We report establishment and characterization of the first-ever bladder carcinosarcoma cell line MaS-3. It is established by the outgrow method from 86 year-old caucasian male who underwent a radical pelvic resection after neoadjuvant radiotherapy. MaS-3 showed carcinosarcoma profile with high conformity with to the original tumour in terms of immunocytochemistry. Proteome analysis also aligned the MaS-3 cell line with the carcinosarcoma specimen rather than corresponding non-malignant tissue. Chemotherapy sensitivity testing revealed a great sensitivity of MaS-3 growth to 5-Fluorouracil, Gemcitabine and Cisplatin, with almost no impact of Irinotecan. Additionally, the suitability of MaS-3 for 3D in vitro experiments was also demonstrated. The newly established cell line MaS-3 shows typical characteristics of the tumour and may thus be a useful in vitro model system for studying the tumour biology and developing future of treatments of this rare but very aggressive entity.

Pelvic reconstruction using an ice-cream cone prosthesis: correlation between the inserted length of the coned stem and surgical outcome.

Acetabular reconstruction using an ice-cream cone prosthesis has been a reliable reconstruction option following pelvic tumour resection. However, it remains unknown which factor determines the success of this procedure. We aimed to determine risk factors for complications and functional loss in acetabular reconstruction using anice-cream cone prosthesis. Fifty-four patients with malignant bone tumours who underwent acetabular reconstruction using an ice-cream cone prosthesis between 2004 and 2016 were studied. The bone-stem ratio was calculated as the ratio of the inserted length into the bone per the entire stem length. A total of 26 (48%) patients had at least one complication and 11 patients (20%) required surgical interventions. The complication rates were 71% and 40% with a bone-stem ratio ≤ 50% and > 50%, respectively (p = 0.026), and the bone-stem ratio significantly stratified the risk of complications (≤ 50%: OR, 4.67 versus > 50%; p = 0.048). The mean MSTS score at the final follow-up was 60% (range 23-97%): the scores were significantly lower in patients with complications/leg-length discrepancy (52%) than in those without (79%; p = 0.002). The mean score with a bone-stem ratio ≤ 50% was significantly lower than the score with a ratio > 50%, especially in patients who underwent non-navigated reconstructions (33% versus 64%; p = 0.001). The inserted length of the coned stem into residual bone was predictive of complications and functional outcome. Surgical indication for this procedure should be considered with the size of the remaining ilium to stabilise the prosthesis with a coned stem longer than half length.

Role of Pelvic Lymph Node Resection in Vulvar Squamous Cell Cancer: A Subset Analysis of the AGO-CaRE-1 Study

BackgroundAs the population at risk for pelvic nodal involvement remains poorly described, the role of pelvic lymphadenectomy (LAE) in vulvar squamous cell cancer (VSCC) has been a matter of discussion for decades.MethodsIn the AGO-CaRE-1 study, 1618 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB or higher primary VSCC treated at 29 centers in Germany between 1998 and 2008 were documented. In this analysis, only patients with pelvic LAE (n = 70) were analyzed with regard to prognosis and correlation between inguinal and pelvic lymph node involvement.ResultsThe majority of patients had T1b/T2 tumors (n = 47; 67.1%), with a median diameter of 40 mm (2–240 mm); 54/70 patients (77.1%) who received pelvic LAE had positive groin nodes. For 42 of these 54 patients, the number of affected groin nodes had been documented as a median of 3; 14/42 (33.3%) of these patients had histologically confirmed pelvic nodal metastases (median number of affected pelvic nodes 3 [1–12]). In these 14 patients, the median number of affected groin nodes was 7 (1–30), with a groin metastases median maximum diameter of 42.5 mm (12–50). Receiver operating characteristic analysis showed an area under the curve of 0.85, with 83.3% sensitivity and 92.6% specificity for the prediction of pelvic involvement in cases of six or more positive groin nodes. No cases of pelvic nodal involvement without groin metastases were observed. Prognosis in cases of pelvic metastasis was poor, with a median progression-free survival of only 12.5 months.ConclusionFor the majority of node-positive patients with VSCC, pelvic nodal staging appears unnecessary since a relevant risk for pelvic nodal involvement only seems to be present in highly node-positive disease.

Prolonged balloon occlusion of the lower abdominal aorta during pelvic or sacral tumor resection.

BackgroundTo explore the efficacy of lower abdominal aorta balloon occlusion technology in pelvis and sacral tumor surgery and to assess the safety of prolonged balloon occlusion.MethodsFrom January 2008 to January 2017, 81 patients were diagnosed with sacrum or pelvic tumor and underwent surgery in our institution. Balloon catheters were placed through the femoral artery to occlude the abdominal aorta of the pelvic tumor and sacrum region undergoing tumor resection. These patients were divided into two group based on single balloon blocking time. Group A had a balloon blocking time of 60 minutes or less, and group B had a balloon occlusion time greater than 60 minutes. The patients in the two groups were compared with regards to operation time, intraoperative blood loss, blood transfusion volume, average length of hospital stay, and postoperative complications.ResultsNo balloon displacement or leakage of the abdominal aorta occurred during the operations. The difference in operation time between the two groups was statistically significant (P≤0.05), and the differences in intraoperative blood loss, blood transfusion volume, and average hospital stay between groups A and B were not significant (P>0.05). The incidence of postoperative complications was 12% in group A, and 22.6% in group B, with no statistically significant differences (P>0.05).ConclusionsProlonged balloon occlusion was safe and effective in the surgical treatment of complicated pelvic and sacral tumors. It did not increase the incidence of postoperative complications such as distal limb paralysis, arterial thrombosis, or ischemic necrosis.

En bloc pelvic resection of ovarian cancer with rectosigmoid colectomy: a literature review.

Maximal cytoreductive surgery is an important prognostic factor in advanced epithelial ovarian cancer (EOC). To achieve maximal cytoreductive surgery, en bloc pelvic resection with rectosigmoid colectomy can be an effective surgical strategy. This surgical methodology was first described in 1968 as "radical oophorectomy." Since then, it has been adopted by many medical institutions around the world, and its safety has been shown by many studies. However, research on the surgical method is still lacking due to the limited number of prospective comparative studies. We will review the journals on en bloc pelvic resection with rectosigmoid colectomy published to date and discuss its efficacy, complications, and surgical techniques of the procedures.

CORR Insights®: Does Adding Femoral Lengthening at the Time of Rotation Hip Transposition After Periacetabular Tumor Resection Allow for Restoration of Limb Length and Function? Interim Results of a Modified Hip Transposition Procedure.

CORR Insights®: Does Adding Femoral Lengthening at the Time of Rotation Hip Transposition After Periacetabular Tumor Resection Allow for Restoration of Limb Length and Function? Interim Results of a Modified Hip Transposition Procedure.

Patient-specific desktop 3D-printed guides for pelvic tumour resection surgery: a precision study on cadavers

3D-printed patient-specific instruments have become a useful tool to improve accuracy in pelvic tumour resections. However, their correct placement can be challenging in some regions due to the morphology of the bone, so it is essential to be aware of the possible placement errors in each region. In this study, we characterize these errors in common pelvic osteotomies. We conducted an experiment with 9 cadaveric specimens, for which we acquired a pre-operative computed tomography scan. Small PSIs were designed for each case following a realistic surgical approach for four regions of the pelvis: iliac crest (C), supra-acetabular (S), ischial (I), and pubic (P). Final surgical placement was based on a post-operative scan. The resulting positions were compared with pre-operative planning, obtaining translations, rotations, and maximum osteotomy deviations in a local reference frame defined based on the bone's morphology. Mean translations and rotations in the direction of the osteotomy plane were as follows: C = 5.3mm, 6.7°; S = 1.8mm, 5.1°; I = 1.5mm, 3.4°; P = 1.8mm, 3.5°. Mean translations in the remaining axes were below 2mm. Maximum osteotomy deviations (75% of cases) were below 11.8mm in C (7.8mm for half-length), 7.8mm in S (5.5mm for half-length), 5.5mm in I, and 3.7mm in P. We have characterized placement errors for small PSIs in four regions of the pelvis. Our results show high errors in C and S PSIs in the direction of the resection plane's normal, and thus large osteotomy deviations. Deviations in short osteotomies in S, I and P and placement errors in the remaining directions were low. The PSIs used in this study are biocompatible and can be produced with a desktop 3D printer, thus minimizing manufacturing cost.