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The Cochrane Database of Systematic... Feb 2014Cancer is a leading cause of death worldwide. Gynaecological cancers (i.e. cancers affecting the ovaries, uterus, cervix, vulva and vagina) are among the most common... (Review)
Review
BACKGROUND
Cancer is a leading cause of death worldwide. Gynaecological cancers (i.e. cancers affecting the ovaries, uterus, cervix, vulva and vagina) are among the most common cancers in women. Unfortunately, given the nature of the disease, cancer can recur or progress in some patients. Although the management of early-stage cancers is relatively straightforward, with lower associated morbidity and mortality, the surgical management of advanced and recurrent cancers (including persistent or progressive cancers) is significantly more complicated, often requiring very extensive procedures. Pelvic exenterative surgery involves removal of some or all of the pelvic organs. Exenterative surgery for persistent or recurrent cancer after initial treatment is difficult and is usually associated with significant perioperative morbidity and mortality. However, it provides women with a chance of cure that otherwise may not be possible. In carefully selected patients, it may also have a place in palliation of symptoms. The biology of recurrent ovarian cancer differs from that of other gynaecological cancers; it is often responsive to chemotherapy and is not included in this review.
OBJECTIVES
To evaluate the effectiveness and safety of exenterative surgery versus other treatment modalities for women with recurrent gynaecological cancer, excluding recurrent ovarian cancer (this is covered in a separate review).
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE up to February 2013. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of clinical guidelines and review articles and contacted experts in the field.
SELECTION CRITERIA
Randomised controlled trials (RCTs) or non-randomised studies with concurrent comparison groups that included multivariate analyses of exenterative surgery versus medical management in women with recurrent gynaecological malignancies.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. No studies were found; therefore no data were analysed.
MAIN RESULTS
The search strategy identified 1311 unique references, of which seven were retrieved in full, as they appeared to be potentially relevant on the basis of title and abstract. However, all were excluded, as they did not meet the inclusion criteria of the review.
AUTHORS' CONCLUSIONS
We found no evidence to inform decisions about exenterative surgery for women with recurrent cervical, endometrial, vaginal or vulvar malignancies. Ideally, a large RCT or, at the very least, well-designed non-randomised studies that use multivariate analysis to adjust for baseline imbalances are needed to compare exenterative surgery versus medical management, including palliative care.
Topics: Adult; Female; Genital Neoplasms, Female; Humans; Neoplasm Recurrence, Local; Pelvic Exenteration
PubMed: 24497188
DOI: 10.1002/14651858.CD010449.pub2 -
Techniques in Coloproctology Dec 2023To mitigate pelvic wound issues following perineal excision of rectal or anal cancer, a number of techniques have been suggested as an alternative to primary closure.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
To mitigate pelvic wound issues following perineal excision of rectal or anal cancer, a number of techniques have been suggested as an alternative to primary closure. These methods include the use of a biological/dual mesh, omentoplasty, muscle flap, and/or pelvic peritoneum closure. The aim of this network analysis was to compare all the available surgical techniques used in the attempt to mitigate issues associated with an empty pelvis.
METHODS
An electronic systematic search using MEDLINE databases (PubMed), EMBASE, and Web of Science was performed (Last date of research was March 15th, 2023). Studies comparing at least two of the aforementioned surgical techniques for perineal wound reconstruction during abdominoperineal resection, pelvic exenteration, or extra levator abdominoperineal excision were included. The incidence of primary healing, complication, and/or reintervention for perineal wound were evaluated. In addition, the overall incidence of perineal hernia was assessed.
RESULTS
Forty-five observational studies and five randomized controlled trials were eligible for inclusion reporting on 146,398 patients. All the surgical techniques had a comparable risk ratio (RR) in terms of primary outcomes. The pooled network analysis showed a lower RR for perineal wound infection when comparing primary closure (RR 0.53; Crl 0.33, 0.89) to muscle flap. The perineal wound dehiscence RR was lower when comparing both omentoplasty (RR 0.59; Crl 0.38, 0.95) and primary closure (RR 0.58; Crl 0.46, 0.77) to muscle flap.
CONCLUSIONS
Surgical options for perineal wound closure have evolved significantly over the last few decades. There remains no clear consensus on the "best" option, and tailoring to the individual remains a critical factor.
Topics: Humans; Network Meta-Analysis; Perineum; Plastic Surgery Procedures; Postoperative Complications; Surgical Flaps
PubMed: 37843643
DOI: 10.1007/s10151-023-02868-1 -
International Urogynecology Journal Jan 2017Neovaginal prolapse (NP) is a rare event as few cases have been reported in the literature. Its management is complex and depends on the initial pathology, the... (Review)
Review
INTRODUCTION AND HYPOTHESIS
Neovaginal prolapse (NP) is a rare event as few cases have been reported in the literature. Its management is complex and depends on the initial pathology, the vaginoplasty technique and the patient's history. We present a review the literature on this rare event.
METHODS
We describe the case of a 72-year-old woman who presented with NP 1 year after pelvic exenteration and radiotherapy for recurrent cervical carcinoma associated with vaginal reconstruction by shaped-tube omentoplasty. She had undergone two previous surgical procedures (posterior sacrospinous ligament suspension and partial colpocleisis), but NP recurred each time within a few months. We performed an anterior approach to the sacrospinous ligament and inserted a mesh under the anterior wall of the neovagina, with the two mesh arms driven through the sacrospinous ligament in a tension-free manner (Uphold Lite® system). The MEDLINE, Cochrane Library, ClinicalTrials and OpenGrey databases were systematically searched for literature on the management of NP following bowel vaginoplasty, mechanical dilatation, graciloplasty, omentoplasty, rectus abdominis myocutaneous flap and the Davydov procedure.
RESULTS
The postoperative course in the patient whose case is described was uneventful and after 1 year of follow-up, the anatomical results and patient satisfaction were good. The systematic search of the databases revealed several studies on the treatment of NP using abdominal and vaginal approaches, and these are reviewed.
CONCLUSIONS
Overall, sacrocolpopexy would appear to be a good option for the treatment of prolapse after bowel vaginoplasty, but too few cases have been reported to establish this technique as the standard management of NP.
Topics: Aged; Carcinoma; Female; Humans; Neoplasm Recurrence, Local; Pelvic Exenteration; Postoperative Complications; Plastic Surgery Procedures; Sacrum; Surgical Mesh; Treatment Outcome; Uterine Cervical Neoplasms; Uterine Prolapse; Vagina
PubMed: 27038991
DOI: 10.1007/s00192-016-3009-5 -
Colorectal Disease : the Official... Dec 2023Locally advanced and recurrent colorectal cancer can require extended surgery, including reconstruction of the vagina. This complex surgery carries high morbidity. The... (Review)
Review
AIM
Locally advanced and recurrent colorectal cancer can require extended surgery, including reconstruction of the vagina. This complex surgery carries high morbidity. The aim of this study was to analyse the impact on female sexual functioning of pelvic exenteration (PE), with or without vaginal flap reconstruction, for locally advanced or recurrent colorectal cancer.
METHOD
The protocol with search strategies for PubMed (Medline), EMBASE and the Cochrane Library was registered in PROSPERO. Studies published from 2000 onwards meeting the inclusion criteria were considered. Study selection (Rayyan), data extraction, rating of evidence (GRADE) and risk of bias (ROBINS-I) were conducted independently by two reviewers.
RESULTS
Six of 2479 identified records were included: four retrospective and two cross-sectional studies. Of all 860 patients included, PE was performed in 314 patients. Seven hundred and thirty-two had rectal cancer (85.1%), 80 nonadvanced rectal cancer (10.9%), 393 locally advanced rectal cancer (53.7%) and 217 locally recurrent rectal cancer (29.6%); for 45 patients the type of rectal cancer remained unspecified (6.1%). Three studies reported on both preoperative and postoperative female sexual activity. Of the 153 women who were sexually active preoperatively, 64 (41.8%) reported postoperative sexual activity. The VRAM flap was used the most frequently and resulted in a sexual activity ratio of 18% postoperatively. Four studies, using six different validated questionnaires, reported mostly lowered sexual functioning postoperatively.
CONCLUSION
Most studies showed that PE can result in severe sexual dysfunction despite reconstruction. Future prospective studies can fill the current knowledge gap by assessing long-term sexual outcomes in women.
Topics: Humans; Female; Retrospective Studies; Prospective Studies; Cross-Sectional Studies; Neoplasm Recurrence, Local; Colorectal Neoplasms; Rectal Neoplasms; Pelvic Exenteration; Postoperative Complications
PubMed: 37872739
DOI: 10.1111/codi.16767 -
Journal of Plastic, Reconstructive &... Mar 2021The vertical rectus abdominis myocutaneous (VRAM) flap is an established technique employed to reconstruct pelvic and perineal defects not amenable to primary closure....
BACKGROUND
The vertical rectus abdominis myocutaneous (VRAM) flap is an established technique employed to reconstruct pelvic and perineal defects not amenable to primary closure. The aim of this study was to systematically review the morbidity of VRAM flap reconstruction following exenterative pelvic surgery.
MATERIALS AND METHODS
A systematic literature search was conducted by using Medline, EMBASE, and Cochrane databases. Abstracts of all studies published from inception to November 2019 were identified. Search terms used included 'vertical rectus abdominis myocutaneous', 'vertical rectus abdominis musculocutaneous' and 'VRAM'. Only studies that described outcomes when a VRAM flap was used during exenterative pelvic surgery were included; case reports were excluded. The primary outcome measure was VRAM flap morbidity. Secondary outcome measures included donor site morbidity and hospital length of stay.
RESULTS
Sixty-five studies with a total of 1827 patients were identified and included. Perineal reconstruction was most commonly performed following abdominal perineal excision of the rectum (APER) (n = 636 and 34.8%). Median patient age at surgery ranged from 38 to 78 years. Mean perineal flap morbidity was 27%, with a complete flap loss rate of 1.8% and a perineal hernia rate of 0.2%. Mean donor site morbidity was 15%, with an abdominal dehiscence rate of 5.5% and an incisional hernia rate of 3.3%.
CONCLUSIONS
While overall morbidity after VRAM flap reconstruction in pelvic visceral surgery is high; the risk of major complications remains low. These data are important when counselling patients for surgery.
Topics: Humans; Myocutaneous Flap; Pelvic Exenteration; Pelvis; Perineum; Postoperative Complications; Plastic Surgery Procedures; Rectus Abdominis; Risk Assessment; Treatment Outcome
PubMed: 33317983
DOI: 10.1016/j.bjps.2020.10.100