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The British Journal of Surgery Jan 2008There is an East-West divide with regard to the frequency, significance and management of lateral pelvic side-wall nodes associated with low rectal cancer. In Japan,... (Review)
Review
BACKGROUND
There is an East-West divide with regard to the frequency, significance and management of lateral pelvic side-wall nodes associated with low rectal cancer. In Japan, removal of nodes is considered essential in curative treatment of selected patients. In the West, involved nodes are generally considered as metastatic disease. There may be international differences in rectal cancer behaviour.
METHODS
A review of relevant studies was undertaken using PubMed, Cochrane Library and personal archives of references; further cross-referencing was conducted. Historical developments, relevant anatomy and reports on lateral pelvic lymphadenectomy (LPLD) were identified. Outcomes following LPLD were assessed.
RESULTS
The low rectum has lateral lymphatic drainage. Enhanced pelvic imaging techniques suggest that some patients with low rectal cancer have lateral pelvic lymph node involvement. However, there is no universal agreement on the definition of either the rectum or low rectal cancer. Selective use of LPLD has led to good outcomes in Japan. An alternative strategy might be neoadjuvant therapy for involved lateral nodes.
CONCLUSION
Pelvic imaging and correlation with pathological findings are crucial in the assessment of lateral pelvic side-wall nodes. East and West should combine their experience of preoperative staging, surgical treatment and pathological assessment of low rectal cancer.
Topics: Europe; Humans; Incidence; Lymph Node Excision; Lymphatic Metastasis; Magnetic Resonance Imaging; Neoplasm Staging; North America; Pelvic Neoplasms; Rectal Neoplasms
PubMed: 18165939
DOI: 10.1002/bjs.6061 -
Bailliere's Clinical Obstetrics and... Mar 1989Spreading intra-abdominally, ovarian cancer reaches the upper abdomen relatively quickly. Metastases result from the implantation of cells from the primary tumour or,... (Review)
Review
Spreading intra-abdominally, ovarian cancer reaches the upper abdomen relatively quickly. Metastases result from the implantation of cells from the primary tumour or, perhaps, may arise de novo from the peritoneal epithelium. The tumour also spreads via the lymphatics directly to the pelvic nodes, directly to the para-aortic nodes, or directly to both. Pelvic nodes were positive in 57.9% of patients of all stages. The highest incidence, 70.4%, was found in Stage III. The percentage of positive para-aortic nodes was lower, namely 50.9% overall incidence and 67.6% in Stage III. Concerning the concomitant involvement of pelvic and para-aortic nodes, 40.4% of patients with positive pelvic nodes also had positive para-aortic nodes. Of patients with negative pelvic nodes, 36.8% also had negative para-aortic nodes. Of all patients, 12.3% had positive pelvic nodes and negative para-aortic nodes. Conversely, 10.5% of all patients had positive para-aortic nodes and negative pelvic nodes. There is a significant association between the involvement of the diaphragm and that of the pelvic and para-aortic nodes. Of those patients with tumour deposits on the diaphragm, 84.4% also had positive retroperitoneal nodes. Conversely, 55.9% of patients with positive nodes also had tumour deposits on the diaphragm. This means that ovarian cancer spreads almost simultaneously in two ways: intra-abdominally and retroperitoneally. Surgical treatment must address both modes.
Topics: Female; Humans; Lymphatic Metastasis; Neoplasm Staging; Ovarian Neoplasms; Pelvic Neoplasms; Peritoneal Neoplasms
PubMed: 2661096
DOI: 10.1016/s0950-3552(89)80036-7 -
Diagnostic and Interventional Radiology... May 2020The incidence of abdominal and pelvic cancer in pregnancy is low, but it is rising as the population of pregnant women gets older. Depending on disease stage,... (Review)
Review
The incidence of abdominal and pelvic cancer in pregnancy is low, but it is rising as the population of pregnant women gets older. Depending on disease stage, gestational age and patient's preference, active surveillance as well as surgery and chemotherapy are feasible options during pregnancy. Correct diagnosis and staging of the tumor is crucial for choosing the best therapeutic approach. Moreover, a reproducible modality to assess the treatment response is requested. Magnetic resonance imaging (MRI) is commonly used with good results for the local staging and treatment response evaluation of most abdominal and pelvic cancers in nonpregnant patients, and it is considered relatively safe during pregnancy. The purpose of this article is to analyze the most relevant topics regarding the use of MRI in pregnant women with abdominal and pelvic cancer. We discuss MRI safety during pregnancy, including the use of gadolinium-based contrast agents (GBCAs), how to prepare the patient for the exam and MRI technique. This will be followed by a brief review on the most common malignancies diagnosed during pregnancy and their MRI appearance.
Topics: Abdomen; Abdominal Neoplasms; Adult; Contrast Media; Female; Gestational Age; Humans; Incidence; Magnetic Resonance Imaging; Neoplasm Staging; Patient Positioning; Patient Preference; Pelvic Neoplasms; Pelvis; Precision Medicine; Pregnancy; Radiologists; Safety; Watchful Waiting
PubMed: 32071031
DOI: 10.5152/dir.2019.19343 -
The Urologic Clinics of North America Aug 2000Rhabdomyosarcoma is the most common soft-tissue sarcoma found in children and can arise almost anywhere skeletal muscle is found. It represents 4% to 8% of malignant... (Review)
Review
Rhabdomyosarcoma is the most common soft-tissue sarcoma found in children and can arise almost anywhere skeletal muscle is found. It represents 4% to 8% of malignant solid tumors in children, ranking behind central nervous system tumors, lymphoma, neuroblastoma, and Wilms' tumor. Reconstructive surgery has become an integral part of the total plan in patients undergoing radical surgery for rhabdomyosarcoma. Advances in surgical techniques can often provide a reasonable lifestyle for patients.
Topics: Child; Female; Humans; Magnetic Resonance Imaging; Neoplasm Staging; Pelvic Neoplasms; Plastic Surgery Procedures; Rhabdomyosarcoma; Tomography, X-Ray Computed; Urinary Diversion; Vaginal Neoplasms
PubMed: 10985148
DOI: 10.1016/s0094-0143(05)70096-3 -
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 -
International Journal of Clinical and... 2015Schwannomas are usually benign tumors that arise from well-differentiated Schwann cells. They rarely occur in the retroperitoneum. Here, we present a case of a... (Review)
Review
Schwannomas are usually benign tumors that arise from well-differentiated Schwann cells. They rarely occur in the retroperitoneum. Here, we present a case of a 60-year-old man with a giant retroperitoneal pelvic mass. Imageological diagnosis suggested a large heterogeneous mass of 16 cm in diameter located in the abdominopelvic retroperitoneum. Complete intralesional enucleation was achieved without any adjacent organs injury except a severe bleeding which was ceased as we applied the bilateral inferior vesical artery embolization. Final histopathological result showed the tumor was a low malignant Schwannoma. The patient's symptoms were greatly improved after operation. Unfortunately, a local recurrence was detected at the six-month follow-up appointment with consequent losing to follow up.
Topics: Biopsy; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Neurilemmoma; Pelvic Neoplasms; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Tumor Burden
PubMed: 26823895
DOI: No ID Found -
AJR. American Journal of Roentgenology Mar 2011
Review
Topics: Cell Transformation, Neoplastic; Contrast Media; Diagnostic Imaging; Female; Genital Neoplasms, Female; Humans; Muscle Neoplasms; Neoplasm Invasiveness; Neoplasm Staging; Pelvic Floor; Pelvic Neoplasms; Sensitivity and Specificity
PubMed: 21343531
DOI: 10.2214/AJR.09.7209 -
The Journal of Surgical Research May 2020Pelvic neuroblastomas are rare and often present in children as massive tumors whose surgical resection can be associated with significant morbidity, given sacral nerve...
BACKGROUND
Pelvic neuroblastomas are rare and often present in children as massive tumors whose surgical resection can be associated with significant morbidity, given sacral nerve root involvement and close proximity to pelvic vascular structures. We sought to examine the characteristics of patients with pelvic neuroblastoma and the effect of extent of surgical resection on survival and surgical outcomes.
MATERIALS AND METHODS
After institutional review board approval, a retrospective chart review was performed at Children's Hospital Los Angeles from 2000 to 2018. Collected data included tumor location, size, image-defined risk factors histology, stage and risk classification, amplification of the oncogene MYCN or N-myc, use of preoperative chemotherapy, and extent of surgical resection. Outcome variables included postoperative complications and survival.
RESULTS
Ten patients with primary pelvic neuroblastoma tumors were identified. The median age at diagnosis was 4.2 y (3 mo to 11 y). Four patients presented with a localized pelvic tumor (stage I or stage II) and underwent upfront tumor resection. Six patients presented with advanced disease (stage III or stage IV) and underwent neoadjuvant chemotherapy, followed by partial resection (30%-90% debulked). One patient experienced a complication: lower extremity hypotonia after tumor resection. One patient died from extensive metastatic disease for which no resection was attempted. The mean postoperative follow-up was 3.9 y with 90% overall survival.
CONCLUSIONS
Our data show that patients who undergo gross total resection for localized pelvic neuroblastoma or neoadjuvant chemotherapy, followed by partial resection for advanced disease have excellent survival. We recommend that small localized pelvic neuroblastoma undergo gross total resection and large unresectable tumors undergo neoadjuvant chemotherapy, followed by partial debulking resection to avoid neurovascular morbidity.
Topics: Antineoplastic Combined Chemotherapy Protocols; Child; Child, Preschool; Cytoreduction Surgical Procedures; Female; Follow-Up Studies; Humans; Infant; Male; Neoadjuvant Therapy; Neoplasm Staging; Neuroblastoma; Pelvic Neoplasms; Pelvis; Postoperative Complications; Retrospective Studies; Risk Assessment; Risk Factors; Survival Analysis; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 31918331
DOI: 10.1016/j.jss.2019.12.009 -
American Journal of Obstetrics and... Jun 1975Pelvic endometriosis may completely obstruct the ureters and destroy the kidneys with little or no gynecologic symptoms. Five cases are discussed, all causing ureteral...
Pelvic endometriosis may completely obstruct the ureters and destroy the kidneys with little or no gynecologic symptoms. Five cases are discussed, all causing ureteral obstruction. Two patients suffered the complete loss of a kidney and in each case the remaining kidney was in jeopardy because of partial obstruction due to endometriosis. All these patients were treated by complete removal of all ovarian tissue, dissection of the ureter, and dissection of the scar tissue. In severe cases, retroperitoneal clamping of the infundibular pelvic ligament with clear exposure of the ureter is mandatory to avoid leaving small remnants of ovary in the infundibular ligament clamp. With complete removal of all ovarian tissue, postoperative estrogen therapy will not cause recurrence of the disease.
Topics: Adult; Castration; Endometriosis; Endometrium; Estrogens; Female; Follow-Up Studies; Humans; Hysterectomy; Middle Aged; Neoplasm Recurrence, Local; Pelvic Neoplasms; Ureter; Ureteral Obstruction; Urinary Bladder; Urography
PubMed: 1146901
DOI: 10.1016/s0002-9378(16)33538-4 -
ANZ Journal of Surgery May 2022To describe our institutional experience in the management of locally advanced primary, and recurrent pelvic sarcoma through pelvic exenteration (PE).
BACKGROUND
To describe our institutional experience in the management of locally advanced primary, and recurrent pelvic sarcoma through pelvic exenteration (PE).
METHODS
Patients undergoing PE for locally advanced primary or recurrent pelvic sarcoma between 2003 and 2017 were identified from a prospectively maintained database at a single quaternary referral hospital in Sydney, Australia were eligible for review. The primary outcomes measured were surgical resection margin and survival. Secondary outcome measures included 30-day morbidity, in hospital length of stay (LOS) and return to theatre.
RESULTS
There were 29 patients who underwent PE for pelvic sarcoma during the study period, with 55% (n = 16) having advanced primary tumours and 45% (n = 13) having recurrent disease. The R0 resection rate was 52% (n = 15); and five-year-survival of 38% (n = 11). The R0 resection was noted to be higher in patients having primary advanced tumours (56%) compared to those with recurrent disease (46%), however this failed to reach statistical significance in this cohort. There was no recorded 30-day mortality. Grade 3 or higher Clavien-Dindo complications were uncommon (14%), but more likely in patients undergoing surgery for recurrent disease (75%).
CONCLUSION
In our cohort of patients with locally advanced and recurrent disease, more than 50% achieved an R0 resection. Recurrent disease makes R0 resection more difficult and can lead to higher morbidity, need for 30-day re-intervention and longer in hospital LOS. PE surgery remains the only curative option for locally advanced, and recurrent sarcoma in the pelvis, and can be performed with acceptable survival and morbidity outcomes.
Topics: Humans; Morbidity; Neoplasm Recurrence, Local; Pelvic Exenteration; Pelvic Neoplasms; Rectal Neoplasms; Retrospective Studies; Sarcoma; Treatment Outcome
PubMed: 34661958
DOI: 10.1111/ans.17275