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Gynecologie, Obstetrique & Fertilite Jan 2012Criteria for patient selection prior to undergo pelvic exenteration have strongly diminished due to improvement in local control of locally advanced tumors treated with... (Review)
Review
Criteria for patient selection prior to undergo pelvic exenteration have strongly diminished due to improvement in local control of locally advanced tumors treated with chemo-radiotherapy. Preoperative study with current image techniques improves the definition of tumor extension to better adapt surgical resection. New haemostatic devices have lead to a reduction in peroperative blood loss. Latero-pelvic extension requires a specific surgical approach with latero-endopelvic résection including vascular and nervous structures and/or intraoperative radiotherapy techniques. Laparoscopic approach is an alternative for selected patients presenting with central tumor. Reconstruction phase is crucial: the pelvic filling diminishes postoperative complications. Continent urinary diversions are the best option for young motivated patients. Pelvic reconstruction, especially by myocutaneous flaps should be systematically proposed to improve body image and cover the pelvis dead space. The development of pelvic isolated perfusion technique will probably emerge as an alternative to pelvic exenteration, or as a neoadjuvant treatment to improve oncological outcomes.
Topics: Female; Humans; Male; Pelvic Exenteration; Pelvic Neoplasms; Pelvis; Plastic Surgery Procedures; Surgical Flaps; Treatment Outcome; Urinary Diversion
PubMed: 22192690
DOI: 10.1016/j.gyobfe.2011.10.008 -
Oncology (Williston Park, N.Y.) Apr 1996Total pelvic exenteration is a radical abdominoperineal operation designed to treat locally extensive pelvic malignancy. In the past, the morbidity and mortality has... (Review)
Review
Total pelvic exenteration is a radical abdominoperineal operation designed to treat locally extensive pelvic malignancy. In the past, the morbidity and mortality has been such that this procedure was considered justified only in the curative setting. As experience has increased and operative survival has improved, the indications for radical pelvic surgery have expanded to include palliation of the symptoms of pelvic tumors, including pain, obstruction, fistulas, and bleeding. The careful selection of suitable candidates for palliative pelvic exenteration requires an extensive preoperative evaluation of the patient's underlying physical and emotional health, as well as an assessment of the local and distant extent of the tumor. In appropriately selected patients, significant palliation of the symptoms associated with an uncontrolled pelvic malignancy can be accomplished with substantial improvement in quality of life.
Topics: Clinical Trials as Topic; Humans; Outcome and Process Assessment, Health Care; Palliative Care; Patient Selection; Pelvic Exenteration; Pelvic Neoplasms; Quality of Life; Survival Rate
PubMed: 8723278
DOI: No ID Found -
European Journal of Surgical Oncology :... Oct 2019Palliative pelvic exenteration (PPE) is a technically complex operation with high morbidity and mortality rates, considered in patients with limited life expectancy....
OBJECTIVE
Palliative pelvic exenteration (PPE) is a technically complex operation with high morbidity and mortality rates, considered in patients with limited life expectancy. There is little evidence to guide practice. We performed a systematic review to evaluate the impact of PPE on symptom relief and quality of life (QoL).
METHODS
A systematic review was conducted according to the PRISMA guidelines using Ovid MEDLINE, EMBASe, and PubMed databases for studies reporting on outcomes of PPE for symptom relief or QoL. Descriptive statistics were used on pooled patient cohorts.
RESULTS
Twenty-three historical cohorts and case series were included, comprising 509 patients. No comparative studies were found. Most malignancies were of colorectal, gynaecological and urological origin. Common indications for PPE were pain, symptomatic fistula, bleeding, malodour, obstruction and pelvic sepsis. The pooled median postoperative morbidity rate was 53.6% (13-100%), the median in-hospital mortality was 6.3% (0-66.7%), and median OS was 14 months (4-40 months). Some symptom relief was reported in a median of 79% (50-100%) of the patients, although the magnitude of effect was poorly measured. Data for QoL measures were inconclusive. Five studies discouraged performing PPE in any patient, while 18 studies concluded that the procedure can be considered in highly selected patients.
CONCLUSION
Available evidence on PPE is of low-quality. Morbidity and mortality rates are high with a short median OS interval. While some symptom relief may be afforded by this procedure, evidence for improvement in QoL is limited. A highly selective individualised approach is required to optimise the risk:benefit equation.
Topics: Humans; Outcome Assessment, Health Care; Palliative Care; Patient-Centered Care; Pelvic Exenteration; Pelvic Neoplasms
PubMed: 31255441
DOI: 10.1016/j.ejso.2019.06.011 -
Actas Urologicas Espanolas Mar 2018To evaluate complications, morbidity and oncologic outcomes of pelvic exenteration as treatment for gynecologic malignancies.
INTRODUCTION AND OBJECTIVE
To evaluate complications, morbidity and oncologic outcomes of pelvic exenteration as treatment for gynecologic malignancies.
MATERIALS AND METHODS
Between 2008 and 2015, a total of 35 patients underwent pelvic exenteration, due to recurrence of gynecological cancer. Surgical outcomes, early and late postoperative complications, and recurrence/survival outcomes were assessed.
RESULTS
Mean patient age was 53.8 years. Anterior exenteration was done in 20 patients, while 15 were total exenterations. Ileal conduit was done in 24 patients, while 8 received a neobladder and 3 a cutaneous ureterostomy. Postoperative complications were divided in 2groups, early (<30 days) and late complications (>30 days). A total of 25 patients (71.4%) had one or more early complications; 16 (45.7%) had fever due to a urinary tract infection, pyelonephritis or intra-abdominal collection; 2 (5.7%) developed a vesicovaginal fistula; 4 (11.4%) a rectovaginal fistula; 3 (8.5%) acute kidney failure and one (2.85%) uronephrosis. Regarding to late complications, 8patients (22.8%) had fever. Six (17%) presented with uronephrosis, and 5 (14.2%) with ureteral-pouch stricture. Five patients (14.2%) had acute renal insufficiency, 3 (8,6%) rectovaginal fistula and one (2.85%) urinary fistula. Mean follow up time was 20.3 month (2-60). A total of 22patients (62.8%) were free of disease. Another 13 (37.1%) patients relapsed. Only 4 (11.4%) patients died after pelvic exenteration due to underlying disease.
CONCLUSION
Pelvic exenteration has a high rate of complications and morbidity, but can be the last curative opportunity in patients with recurrent or persistent gynecologic malignancies. This procedure should be performed by multidisciplinary, experienced teams in a tertiary medical center.
Topics: Adult; Aged; Disease-Free Survival; Female; Follow-Up Studies; Genital Neoplasms, Female; Humans; Middle Aged; Neoplasm Recurrence, Local; Pelvic Exenteration; Postoperative Complications; Procedures and Techniques Utilization; Salvage Therapy; Treatment Outcome; Urinary Diversion
PubMed: 28911880
DOI: 10.1016/j.acuro.2017.05.004 -
Zentralblatt Fur Chirurgie Apr 2015Soft tissue defects after oncological pelvic exenteration still represent a significant problem. Because of the anatomic and functional peculiarities, the reconstruction... (Review)
Review
Soft tissue defects after oncological pelvic exenteration still represent a significant problem. Because of the anatomic and functional peculiarities, the reconstruction of defects in the pelvic region is challenging and requires a differentiated approach. In this paper, current strategies and options for reconstructive procedures are presented considering preoperative conditions and factors related to surgical planning. The relevance of interdisciplinary collaboration and the resulting benefits are set out. The inclusion of the plastic surgeon already in the preoperative planning of tumour resection is recommended.
Topics: Combined Modality Therapy; Cooperative Behavior; Humans; Interdisciplinary Communication; Neoadjuvant Therapy; Patient Care Planning; Pelvic Exenteration; Pelvic Neoplasms; Plastic Surgery Procedures; Surgical Flaps
PubMed: 25723865
DOI: 10.1055/s-0034-1396161 -
Annals of Surgical Oncology May 2019Pelvic exenteration (PE) is a complex and challenging surgical procedure. The reported results of this procedure for primary and recurrent disease are limited and...
BACKGROUND
Pelvic exenteration (PE) is a complex and challenging surgical procedure. The reported results of this procedure for primary and recurrent disease are limited and conflicting.
METHODS
This study analyzed patient outcomes after all PEs performed in the authors' department between October 2001 and December 2016. Relevant patient data were obtained from a prospective database. Morbidity and mortality were reported for all patients. For patients with malignant disease, differences in perioperative outcomes, prognostic indicators for overall survival, and local and systemic disease recurrence were analyzed using uni- and multivariate analyses.
RESULTS
The study enrolled 187 patients. Of the 183 patients with malignant disease, 63 (38.2%) had primary locally advanced tumors and 115 (62.5%) had recurrent tumors. The 10-year overall survival rate was 63.5% for the patients with primary tumors that were curatively resected and 20.9% for the patients with recurrent disease (p = 0.02). The 10-year survival rate for the patients with extrapelvic disease who underwent curative resection was 37%. Multivariable analysis identified margin positivity (p < 0.01), surgery lasting longer than 7 h (p = 0.02), and recurrent disease (p < 0.01) as predictors of poor survival. Multivariate analysis of local and systemic disease recurrence showed recurrent disease (p < 0.01) as the only significant prognostic factor.
CONCLUSIONS
Pelvic exenteration has good long-term results, even for patients with extrapelvic disease. The oncologic outcome for patients with recurrent disease is worse than for patients with primary disease. However, even for these patients, long-time survival is possible.
Topics: Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasms; Pelvic Exenteration; Postoperative Complications; Prognosis; Prospective Studies; Survival Rate
PubMed: 30519763
DOI: 10.1245/s10434-018-07090-0 -
Surgical Oncology Clinics of North... Jul 2005
Review
Topics: Contraindications; Female; History, 20th Century; Humans; Laparoscopy; Magnetic Resonance Imaging; Missouri; Patient Selection; Pelvic Exenteration; Positron-Emission Tomography; Rectal Neoplasms; Survival Analysis; Tomography, X-Ray Computed
PubMed: 15978431
DOI: 10.1016/j.soc.2005.05.005 -
Surgery Today Dec 2016Pelvic infection is a significant clinical problem after pelvic exenteration. The clinical benefit of an omental flap in reducing the incidence of such infections is...
Pelvic infection is a significant clinical problem after pelvic exenteration. The clinical benefit of an omental flap in reducing the incidence of such infections is unknown. The aim of this study was to evaluate whether an omental flap after pelvic exenteration reduces the incidence of pelvic infection and the length of postoperative hospital stay. In this study, we demonstrate a safe, effective, simple method for reducing the incidence of pelvic infection using an omental flap. We performed pelvic exenteration for tumors that were suspected to have extensive invasion to the bladder, prostate, or uterus. The omentum was dissected from the transverse colon and greater curvature of the stomach. The flap was based on the right gastroepiploic vessels and tunneled in the retrocolic plane, through the mesentery of the transverse colon and ileocecum, to the defect. Twenty-seven patients were analyzed retrospectively. Ten patients received omental flaps, and 17 patients underwent pelvic exenteration without an omental flap. The incidence of pelvic infection was significantly reduced in the patients with omental flaps.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Omentum; Pelvic Exenteration; Pelvic Infection; Pelvic Neoplasms; Postoperative Complications; Retrospective Studies; Surgical Flaps; Treatment Outcome
PubMed: 27226018
DOI: 10.1007/s00595-016-1348-y -
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 -
Ceska Gynekologie Jan 2005Review of literature concerning pelvic exenterative procedures. (Review)
Review
OBJECTIVE
Review of literature concerning pelvic exenterative procedures.
DESIGN
Review article.
SETTING
Department of Obstetrics and Gynecology, Charles University, Prague.
METHODS
Review and critical assessment of published data.
CONCLUSION
Pelvic exenterations are standard procedures in oncogynecology which have no alternative in certain indications. The most frequent indications are recurrences or progressions of cervical, vulva or vaginal cancers. Exenterative procedures might be used in primary treatment in some cases of locally advanced tumors. Mortality of current procedures reaches 5% to 10%, early and late postoperative morbidity is frequent (40-60%). Recently explorative laparoscopy is used in preoperative staging to decrease the number of aborted procedures due to distant metastasis or pelvic tumor inoperability. The procedure with high morbidity, causing impairment of quality of life, is justified due to good follow-up results--5-years overall survival is about 50-60%. It should be emphasized that with no treatment in these patients median of survival reaches about 6 months.
Topics: Female; Genital Neoplasms, Female; Humans; Patient Selection; Pelvic Exenteration; Prognosis
PubMed: 15779294
DOI: No ID Found