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American Journal of Obstetrics and... Dec 1977An analysis of 296 patients who had pelvic exenteration discloses a high risk of postoperative complications and death; however, the safety has been improved by...
An analysis of 296 patients who had pelvic exenteration discloses a high risk of postoperative complications and death; however, the safety has been improved by technical modifications for urinary diversion and treatment of the denuded pelvic cavity. Recurrent cancer of the cervix or vagina was the main reason for the operation. Prognostic factors were sought to improve selection of patients who are able to withstand operation, tolerate postoperative complications, and remain free of cancer. The five-year survival rate for 296 patients with various types of cancer calculated by the Berkson-Gage method was 56.5 per cent after death from all causes were deducted, the rate was 42.1 per cent. The five-year survival rate for 196 patients with recurrent carcinoma of the cervix calculated by the Berkson-Gage method was 48.3 per cent; after deaths from all causes were deducted, the rate was 33.8 per cent.
Topics: Blood Volume; Female; Humans; Infusions, Parenteral; Neoplasm Recurrence, Local; Pelvic Exenteration; Postoperative Complications; Prognosis; Risk; Urinary Diversion; Uterine Cervical Neoplasms; Vagina; Vaginal Neoplasms
PubMed: 930972
DOI: 10.1016/0002-9378(77)90521-x -
European Journal of Surgical Oncology :... Nov 2022
Topics: Humans; Pelvic Neoplasms; Pelvic Exenteration; Pelvis
PubMed: 36319486
DOI: 10.1016/j.ejso.2022.09.017 -
Zhonghua Wei Chang Wai Ke Za Zhi =... Mar 2023In recent years, with advances in pelvic oncology and surgical techniques, surgeons have redefined the boundaries of pelvic surgery. Combined pelvic exenteration is now...
In recent years, with advances in pelvic oncology and surgical techniques, surgeons have redefined the boundaries of pelvic surgery. Combined pelvic exenteration is now considered the treatment of choice for some patients with locally advanced and locally recurrent rectal cancer, but it is only performed in a few hospitals in China due to the complexity of the procedure and the large extent of resection, complications, and high perioperative mortality. Although there have been great advances in oncologic drugs and surgical techniques and equipment in recent years, there are still many controversies and challenges in the preoperative assessment of combined pelvic organ resection, neoadjuvant treatment selection and perioperative treatment strategies. Adequate understanding of the anatomical features of the pelvic organs, close collaboration of the clinical multidisciplinary team, objective assessment and standardized preoperative combination therapy creates the conditions for radical surgical resection of recurrent and complex locally advanced rectal cancer, while the need for rational and standardized R0 resection still has the potential to bring new hope to patients with locally advanced and recurrent rectal cancer.
Topics: Humans; Pelvic Exenteration; Neoplasm Recurrence, Local; Rectum; Rectal Neoplasms; Pelvis; Treatment Outcome; Retrospective Studies
PubMed: 36925120
DOI: 10.3760/cma.j.cn441530-20221123-00488 -
Gynecologic Oncology Jul 2022The aim of the study was to compare health-related quality of life (QoL) and oncological outcome between gynaecological cancer patients undergoing pelvic exenteration...
BACKGROUND
The aim of the study was to compare health-related quality of life (QoL) and oncological outcome between gynaecological cancer patients undergoing pelvic exenteration (PE) and extended pelvic exenteration (EPE). EPEs were defined as extensive procedures including, in addition to standard PE extent, the resection of internal, external, or common iliac vessels; pelvic side-wall muscles; large pelvic nerves (sciatic or femoral); and/or pelvic bones.
METHODS
Data from 74 patients who underwent PE (42) or EPE (32) between 2004 and 2019 at a single tertiary gynae-oncology centre in Prague were analysed. QoL assessment was performed using EORTC QLQ-C30, EORTC CX-24, and QOLPEX questionnaires specifically developed for patients after (E)PE.
RESULTS
No significant differences in survival were observed between the groups (P > 0.999), with median overall and disease-specific survival in the whole cohort of 45 and 49 months, respectively. Thirty-one survivors participated in the QoL surveys (20 PE, 11 EPE). No significant differences were observed in global health status (P = 0.951) or in any of the functional scales. The groups were not differing in therapy satisfaction (P = 0.502), and both expressed similar, high willingness to undergo treatment again if they were to decide again (P = 0.317).
CONCLUSIONS
EPEs had post-treatment QoL and oncological outcome comparable to traditional PE. These procedures offer a potentially curative treatment option for patients with persistent or recurrent pelvic tumour invading into pelvic wall structures without further compromise of patients´ QoL.
Topics: Humans; Pelvic Exenteration; Pelvic Neoplasms; Quality of Life; Retrospective Studies; Surveys and Questionnaires
PubMed: 35568583
DOI: 10.1016/j.ygyno.2022.04.022 -
Colorectal Disease : the Official... Jan 2024The aim of this study was to investigate the role of human factors in pelvic exenteration and how team performance is optimized in the preoperative, intraoperative and...
AIM
The aim of this study was to investigate the role of human factors in pelvic exenteration and how team performance is optimized in the preoperative, intraoperative and postoperative phases.
METHOD
Qualitative analysis of focus groups was used to capture authentic human interactions that reflect real-world multiprofessional performance. Theatre teams were treated as clusters, with a particular focus group containing participants who worked together regularly.
RESULTS
Three focus groups were conducted. Four themes emerged - driving force, technical skills, nontechnical skills and operational aspects - with a total of 16 subthemes. Saturation was reached by group 2, with no new subthemes emerging after this. There was some interaction between the themes and the subthemes. Broadly speaking, driving force led to the development of specialised technical skills and nontechnical skills, which were operationalized into successful service through operational aspects.
CONCLUSION
This study of teams performing pelvic exenteration is the first in the field using this methodology. It has generated rich qualitative data with authentic insights into the pragmatic aspects of developing and delivering a service. In addition, it shows how the themes are connected or 'coupled' in a network, for example technical and non-technical skills. In a complex system, 'tight coupling' leads to both high performance and adverse events. In this paper, we report the qualitative aspects of high performance by pelvic exenteration teams in a complex sociotechnical system, which depends on tight coupling of several themes.
Topics: Humans; Pelvic Exenteration; Focus Groups
PubMed: 38057630
DOI: 10.1111/codi.16825 -
The British Journal of Surgery Feb 2014Pelvic exenteration is highly radical surgery offering the only potential cure for locally advanced pelvic cancer. This study compared quality of life and other relevant... (Comparative Study)
Comparative Study
BACKGROUND
Pelvic exenteration is highly radical surgery offering the only potential cure for locally advanced pelvic cancer. This study compared quality of life and other relevant patient-reported outcomes over 12 months for patients who did and those who did not undergo pelvic exenteration.
METHODS
Consecutive patients referred for consideration of pelvic exenteration completed clinical and patient-reported outcome assessments at baseline, hospital discharge (exenteration patients only), and 1, 3, 6, 9 and 12 months. Outcomes included cancer-specific quality of life (Functional Assessment of Cancer Therapy - Colorectal; FACT-C), physical and mental health status (Short Form 36 version 2), psychological distress (Distress Thermometer), and pain (study-specific composite) scores. Linear mixed modelling compared trajectories between exenteration and no-exenteration groups.
RESULTS
Among 182 patients, 148 (81.3 per cent) proceeded to exenteration. There were no baseline differences between the two groups. Among patients who had exenteration, the mean FACT-C score at baseline of 93.0 had reduced by 14·4 points at hospital discharge, but increased to 86·7 at 1 month after surgery and continued to improve, returning to baseline by 9 months. For patients in the no-exenteration group, FACT-C scores decreased between baseline and 1 month, increased slowly to 6 months and then began to decline at 9 months. There were few statistically or clinically significant differences in any patient-reported outcomes between the groups.
CONCLUSION
Quality of life and related patient-reported outcomes improve rapidly after pelvic exenteration surgery. For 9 months after surgery, these outcomes are comparable with those of similar do patients who do not have surgery; thereafter, there is a decline in patients who do not have exenteration. Pelvic exenteration can be performed with acceptable quality of life and patient-reported outcomes.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Pelvic Exenteration; Pelvic Neoplasms; Quality of Life; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 24420909
DOI: 10.1002/bjs.9392 -
International Journal of Gynecological... Oct 2023
Topics: Female; Humans; Rectum; Pelvic Exenteration; Vagina; Neoplasms; Perineum; Laparoscopy; Rectal Neoplasms
PubMed: 37094969
DOI: 10.1136/ijgc-2023-004283 -
European Journal of Obstetrics,... Oct 2007Analyse the outcome of pelvic exenteration for gynaecological malignancies in a tertiary referral center. Post-operative in-hospital morbidity, long-term morbidity,...
OBJECTIVE
Analyse the outcome of pelvic exenteration for gynaecological malignancies in a tertiary referral center. Post-operative in-hospital morbidity, long-term morbidity, disease free and overall survival rates were studied.
STUDY DESIGN
Between 1991 and 2004, 42 patients underwent an anterior, total or posterior exenteration for gynaecological malignancies. Follow-up was obtained from patient files; disease free and overall survival were calculated and prognostic factors were studied.
RESULTS
A pelvic exenteration was performed in 14 patients for primary and 28 patients for recurrent gynaecological cancers. In-hospital complications occurred in 19 patients (45%) of whom seven patients needed a reoperation (17%). Late complications occurred in 31 patients (75%); 21 reinterventions were performed (50%). Five-year disease free and overall survival was, respectively, 48 and 52%. Age, type of surgery, histology, localisation of the tumour, lateral wall involvement, completeness of resection and primary versus recurrent cancer were not identified as prognostic factors for recurrence or survival.
CONCLUSION
Long-term survival is possible in about 50% of patients after pelvic exenteration for gynaecological cancers, but is associated with significant post-operative morbidity.
Topics: Adult; Aged; Disease-Free Survival; Female; Genital Neoplasms, Female; Humans; Middle Aged; Morbidity; Neoplasm Recurrence, Local; Netherlands; Pelvic Exenteration; Postoperative Complications; Retrospective Studies
PubMed: 16950559
DOI: 10.1016/j.ejogrb.2006.07.025 -
Surgical Oncology Mar 2019
Topics: Female; Humans; Laparoscopy; Pelvic Exenteration; Pelvis; Prognosis; Retroperitoneal Space; Ureter; Uterine Cervical Neoplasms; Video Recording
PubMed: 30851882
DOI: 10.1016/j.suronc.2018.11.020 -
Bulletin Du Cancer Dec 2002Pelvic exenteration can be proposed to non-metastatic patients with advanced or recurrent pelvic cancer and remains frequently the only potentially curative option in... (Review)
Review
Pelvic exenteration can be proposed to non-metastatic patients with advanced or recurrent pelvic cancer and remains frequently the only potentially curative option in combination with others therapies. Colorectal function preservation and reconstructive procedures are useful to decrease functional and psychologic impact and postoperative morbidity. Technical procedures including urinary diversion, colorectal function preservation, vaginal reconstruction and pelvic filling are described and commented. Specific morbidity is analysed.
Topics: Anastomosis, Surgical; Colon; Female; Humans; Pelvic Exenteration; Pelvic Neoplasms; Rectum; Urinary Diversion; Vagina
PubMed: 12525365
DOI: No ID Found