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Oncology (Williston Park, N.Y.) Apr 2017Sexual and urinary morbidities resulting from treatment of pelvic malignancies are common. These treatment sequelae are significantly bothersome to patients and... (Review)
Review
Sexual and urinary morbidities resulting from treatment of pelvic malignancies are common. These treatment sequelae are significantly bothersome to patients and challenging to address. Awareness of these complications is critical in order to properly counsel patients regarding potential side effects and to facilitate prompt diagnosis and management. Addressing these issues often necessitates a coordinated multidisciplinary approach; however, the effort required often translates into improvement in patient quality of life. Herein we review the sexual and urinary side effects that may arise during or after treatment of pelvic malignancies.
Topics: Cancer Survivors; Humans; Pelvic Neoplasms; Quality of Life; Sexual Dysfunctions, Psychological; Urinary Incontinence, Stress
PubMed: 28412780
DOI: No ID Found -
Spine Jun 2020Retrospective analysis.
STUDY DESIGN
Retrospective analysis.
OBJECTIVE
Our goal was to provide a predictive model and a risk classification system that predicts cancer-specific survival (CSS) from spinal and pelvic tumors.
SUMMARY OF BACKGROUND DATA
Primary bone tumors of the spinal and pelvic are rare, thus limiting the understanding of the manifestations and survival from these tumors. Nomograms are the graphical representation of mathematical relationships or laws that accurately predict individual survival.
METHODS
A total of 1033 patients with spinal and pelvic bone tumors between 2004 and 2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate Cox analysis was used on the training set to select significant predictors to build a nomogram that predicted 3- and 5-year CSS. We validate the precision of the nomogram by discrimination and calibration, and the clinical value of nomogram was assessed by making use of a decision curve analyses (DCA).
RESULTS
Data from 1033 patients with initially-diagnosed spinal and pelvic tumors were extracted from the SEER database. Multivariate analysis of the training cohort, predictors included in the nomogram were age, pathological type, tumor stage, and surgery. The value of C-index was 0.711 and 0.743 for the internal and external validation sets, respectively, indicating good agreement with actual CSS. The internal and external calibration curves revealed good correlation of CSS between the actual observation and the nomogram. Then, the DCA showed greater net benefits than that of treat-all or treat-none at all time points. A novel risk grouping system was established for CSS that can readily divide all patients into three distinct risk groups.
CONCLUSION
The proposed nomogram obtained more precision prognostic prediction for patients with initially-diagnosed primary spinal and pelvic tumors.
LEVEL OF EVIDENCE
3.
Topics: Adult; Bone Neoplasms; Cohort Studies; Decision Support Techniques; Female; Humans; Male; Middle Aged; Neoplasm Staging; Nomograms; Pelvic Neoplasms; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Factors; SEER Program
PubMed: 32039945
DOI: 10.1097/BRS.0000000000003404 -
Oncology Research and Treatment 2016Depending on the stage at initial presentation, cervical cancer will recur in 25-61% of women. Typical manifestations of recurrent cervical cancer include the central... (Review)
Review
Depending on the stage at initial presentation, cervical cancer will recur in 25-61% of women. Typical manifestations of recurrent cervical cancer include the central pelvis and the pelvic side walls as well as retroperitoneal lymph node basins in the pelvis and the para-aortic region, and - more rarely - supraclavicular lymph nodes. There are no typical symptoms of recurrent cervical cancer. Women with suspected recurrence after cervical cancer based on gynecological examination or organ-specific symptoms must undergo imaging studies and - if technically feasible - biopsy with histological verification, especially in cases of distant metastases, in order to rule out a second primary. Radiotherapy-naïve women should be treated with salvage radiochemotherapy with curative intention. For women with previous radiotherapy, surgery in the form of hysterectomy, local resection, or pelvic exenteration is the treatment of choice. Pelvic exenteration can lead to cure in selected patients, but at the price of a high rate of complications and significant morbidity and mortality. If complete surgical resection is not feasible or if the woman is not a candidate for surgery, chemotherapy with palliative intent should be offered. Patients with recurrent disease outside the pelvis are candidates for systemic chemotherapy. Several agents have shown to be active in this situation, either in single-agent or combination regimens. Platinum-containing regimens have a superior efficacy over non-platinum regimens and bevacizumab may be added to chemotherapy.
Topics: Chemoradiotherapy; Combined Modality Therapy; Evidence-Based Medicine; Female; Humans; Hysterectomy; Neoplasm Recurrence, Local; Pelvic Exenteration; Pelvic Neoplasms; Treatment Outcome; Uterine Cervical Neoplasms
PubMed: 27614445
DOI: 10.1159/000448529 -
International Journal of Surgery... Apr 2024The diagnostic ability of endoscopic ultrasound (EUS) for intestinal infiltration by pelvic masses has aroused considerable interest in many oncological settings. This...
BACKGROUND
The diagnostic ability of endoscopic ultrasound (EUS) for intestinal infiltration by pelvic masses has aroused considerable interest in many oncological settings. This study aimed to evaluate the effectiveness of EUS in predicting colorectal invasion in patients with pelvic masses and compare its accuracy with that of other imaging methods, namely pelvic MRI and abdominal computed tomography (CT), in predicting intestinal involvement in patients with histologically confirmed colorectal invasion.
METHODS
A hundred and eighty-four female patients with histologically confirmed benign or malignant pelvic masses were enrolled in a retrospective-prospective study. All patients underwent EUS, pelvic MRI, and one or more of abdominal CT, transvaginal sonography, and colonoscopy examinations before surgery. The surgical and pathological results were used as the gold standard to evaluate the diagnostic accuracy of EUS for colorectal invasion of pelvic masses.
RESULTS
This study included 184 patients who underwent surgery, with the time between EUS and surgery ranging from 1 to 309 (mean, 13.2) days. The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of EUS for benign and malignant pelvic masses infiltrating the intestine were 83.3, 97.8, 99.1, and 66.2%, respectively. The overall diagnostic accuracy was 87.0%.
CONCLUSIONS
EUS is a simple, noninvasive, reliable, and accurate technique for the preoperative diagnosis of pelvic masses infiltrating the intestine. The authors recommend the use of this technology by gynecologists, as well as its incorporation into the preoperative diagnostic process to determine the most suitable surgical method. This would help in avoiding unexpected situations and unnecessary resource wastage during surgery.
Topics: Humans; Female; Endosonography; Middle Aged; Adult; Aged; Retrospective Studies; Pelvic Neoplasms; Prospective Studies; Aged, 80 and over; Sensitivity and Specificity; Young Adult; Neoplasm Invasiveness; Tomography, X-Ray Computed; Magnetic Resonance Imaging
PubMed: 38668660
DOI: 10.1097/JS9.0000000000001124 -
The British Journal of Surgery Jul 2023
Topics: Humans; Pelvic Exenteration; Pelvic Neoplasms; Robotic Surgical Procedures; Neoplasm Recurrence, Local; Pelvis; Retrospective Studies
PubMed: 36441181
DOI: 10.1093/bjs/znac422 -
The American Journal of Hospice &... Jul 2017Pain is a common and debilitating symptom in pelvic cancer diseases. Failure in controlling this pain through pharmacological approaches calls for employing multimodal... (Review)
Review
Pain is a common and debilitating symptom in pelvic cancer diseases. Failure in controlling this pain through pharmacological approaches calls for employing multimodal management and invasive techniques. Various strategies are commonly used for this purpose, including palliative radiotherapy, epidural medications and intrathecal administration of analgesic and local anesthetic drugs with pumps, and neural or plexus blockade. This review focuses on the features of minimally invasive palliative procedures (MIPPs), such as radiofrequency ablation, laser-induced thermotherapy, cryoablation, irreversible electroporation, electrochemotherapy, microwave ablation, and cementoplasty as well as their role in palliation of cancer pelvic pain. Despite the evidence of effectiveness and safety of these interventions, there are still many barriers to accessing MIPPs, including the availability of trained staff, the lack of precise criteria of indication, and the high costs.
Topics: Adult; Aged; Aged, 80 and over; Cancer Pain; Female; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Pain Management; Palliative Care; Pelvic Neoplasms; Withholding Treatment
PubMed: 26936922
DOI: 10.1177/1049909116636374 -
Journal of Biomaterials Applications Apr 2023The purpose of this study is to explore the effect of using 3D printed pelvic prosthesis to reconstruct bone defect after pelvic tumor resection. From June 2018 to...
The purpose of this study is to explore the effect of using 3D printed pelvic prosthesis to reconstruct bone defect after pelvic tumor resection. From June 2018 to October 2021, a total of 10 patients with pelvic tumors underwent pelvic tumor resection and 3D printed customized hemipelvic prosthesis reconstruction in our hospital. Enneking pelvic surgery subdivision method was used to determine the degree of tumor invasion and the site of prosthesis reconstruction. 2 cases in Zone I, 2 cases in Zone II, 3 cases in Zone I + II, 2 cases in Zone II + III and 1 case in Zone I + II + III. Patients had preoperative VAS scores of 6.5 ± 1.3, postoperative VAS scores of 2.2 ± 0.9, preoperative MSTS-93 scores of 9.4 ± 5.3 and postoperative 19.4 ± 5.9( < 0.05), all patients had improvement in pain after surgery; Postoperative complications included joint dislocation in 2 cases, myasthenia caused by Guillain-Barre syndrome in 1 case, delayed wound healing in 3 cases and wound infection in 2 cases. Postoperative wound-related complications and dislocations were associated with the extent of the tumor. Patients with tumor invasion of the iliopsoas and gluteus medius muscles had higher complication rates and worse postoperative MSTS scores ( < 0.05). The patients were followed up for 8 ∼ 28 months. During the follow-up period, 1 case recurred, 4 cases metastasized and 1 case died. All pelvic CTs reviewed 3-6 months after surgery showed good alignment between the 3D printed prosthesis and the bone contact, and tomography showed the growth of trabecular structures into the bone. Overall pain scores decreased and functional scores improved in patients after 3D printed prosthesis replacement for pelvic tumor resection. Long-term bone ingrowth could be seen on the prosthesis-bone contact surface with good stability.
Topics: Humans; Pelvic Neoplasms; Bone Neoplasms; Prosthesis Implantation; Postoperative Complications; Printing, Three-Dimensional; Pain; Retrospective Studies; Treatment Outcome
PubMed: 36847197
DOI: 10.1177/08853282231161110 -
Minimally invasive surgery techniques in pelvic exenteration: a systematic and meta-analysis review.Surgical Endoscopy Dec 2018Pelvic exenteration is potentially curative for locally advanced and recurrent pelvic cancers. Evolving technology has facilitated the use of minimally invasive surgical... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pelvic exenteration is potentially curative for locally advanced and recurrent pelvic cancers. Evolving technology has facilitated the use of minimally invasive surgical (MIS) techniques in selected cases. We aimed to compare outcomes between open and MIS pelvic exenteration.
METHODS
A review of comparative studies was performed. Firstly, we evaluated the differences in surgical techniques with respect to operative time, blood loss, and margin status. Secondly, we assessed differences in 30-day morbidity and mortality rates, and length of hospital stay.
RESULTS
Four studies that directly compared open and MIS exenteration were included. Analysis was performed on 170 patients; 78.1% (n = 133) had open pelvic exenteration, while 21.8% (n = 37) had a MIS exenteration. The median age for open exenteration was 57.7 years versus 63 years for MIS exenteration. Even though the operative time for MIS exenteration was 83 min longer (p < 0.001), it was associated with a median of 1,750mls less blood loss. The morbidity rate for MIS exenterative group was 56.7% (n = 21/37) versus 88.5% (n = 85/96) in the open exenteration group, with pooled analysis observing a 1.17 relative risk increase in 30-day morbidity (p = 0.172) in the open exenteration group. In addition, the MIS cohort had a 6-day shorter length of hospital stay (p = 0.04).
CONCLUSION
MIS exenteration can be performed in highly selective cases, where there is favourable patient anatomy and tumour characteristics. When feasible, it is associated with reduced intra-operative blood loss, shorter length of hospital stay, and reduced morbidity.
Topics: Humans; Minimally Invasive Surgical Procedures; Neoplasm Staging; Outcome and Process Assessment, Health Care; Patient Selection; Pelvic Exenteration; Pelvic Neoplasms
PubMed: 30019221
DOI: 10.1007/s00464-018-6299-5 -
The British Journal of Radiology 2016Our objective is to describe an approach for retrorectal/presacral mass evaluation on imaging with attention to imaging features, allowing for refinement of the... (Review)
Review
Our objective is to describe an approach for retrorectal/presacral mass evaluation on imaging with attention to imaging features, allowing for refinement of the differential diagnosis of these masses. Elaborate on clinically relevant features that may affect biopsy or surgical approach, of which the radiologist should be aware. A review of current literature regarding the diagnosis and treatment of retrorectal/presacral masses was performed with attention to specific findings, which may lend refinement to the differential diagnosis of these masses. Cases were obtained by searching through a radiology database at a single institution after Institutional Review Board approval. Recent advances in imaging and treatment methods have led to the increased role of radiology in both imaging and tissue diagnosis of retrorectal masses. Surgical philosophies surrounding the treatment of these masses have not significantly changed in recent years, but there are a few key factors of which the radiologist must be aware. The radiologist can offer refinement of the differential diagnosis of retrorectal masses and can elaborate on salient findings which could alter the need for neoadjuvant chemoradiation therapy, pre-surgical tissue diagnosis and surgical approach. This article presents an imaging approach to retrorectal/presacral masses with emphasis on findings which can dictate the ultimate need for neoadjuvant therapy and pre-surgical tissue diagnosis and alter the preferred surgical approach. This article consolidates key findings, so radiologists can become more clinically relevant in the evaluation of these masses.
Topics: Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Pelvic Neoplasms; Sacrococcygeal Region; Tomography, X-Ray Computed
PubMed: 26828969
DOI: 10.1259/bjr.20150698 -
Diseases of the Colon and Rectum Nov 2016Locally advanced pelvic malignancy can be associated with disabling symptoms and reduced quality of life. If resectable with clear margins, a pelvic exenteration can...
BACKGROUND
Locally advanced pelvic malignancy can be associated with disabling symptoms and reduced quality of life. If resectable with clear margins, a pelvic exenteration can offer long-term survival and improved quality of life. Its role in the palliation of symptoms has been described; however, the clinical outcomes and surgical indication are poorly defined.
OBJECTIVE
This study describes the clinical and quality-of-life outcomes after palliative pelvic exenteration for advanced pelvic malignancy.
DESIGN
Clinical data and patient-reported outcomes were collected for patients undergoing pelvic exenteration for symptom palliation.
SETTINGS
This study was conducted at a tertiary referral center for pelvic exenteration.
PATIENTS
All of the patients undergoing palliative pelvic exenteration for advanced primary rectal or recurrent cancer were included in our analysis.
MAIN OUTCOME MEASURES
Patient-reported quality of life and physical and mental health status were measured. Quality-of-life trajectories were modeled over the 12 months from the date of surgery using linear mixed models.
RESULTS
A total of 39 patients underwent pelvic exenteration for symptom palliation. Although there were no in-hospital deaths, 34% experienced significant morbidity. Patient-reported quality of life reduced postoperatively and gradually declined thereafter. Overall median survival was 24 months, with a 1-year mortality rate of 31%. There was a significant survival difference for the 39 patients undergoing pelvic exenteration compared with those patients who only had a debulking/bypass procedure or were closed without definitive treatment (overall median survival = 24 versus 9 months; p = <0.02).
LIMITATIONS
Disease and patient heterogeneity limit the interpretation of these results.
CONCLUSIONS
Palliative pelvic exenteration is a technically demanding operation that can be performed safely in a dedicated exenteration center. However, no durable palliation of symptoms with associated improved or sustained quality of life was observed, and the role of palliation therefore remains highly controversial in this complex group of patients.
Topics: Adult; Aged; Australia; Female; Hospital Mortality; Humans; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Palliative Care; Pelvic Exenteration; Pelvic Neoplasms; Postoperative Period; Quality of Life; Survival Analysis
PubMed: 27749474
DOI: 10.1097/DCR.0000000000000679