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BMJ Open Feb 2024The empty pelvis syndrome is a significant source of morbidity following pelvic exenteration surgery. It remains poorly defined with research in this field being...
INTRODUCTION
The empty pelvis syndrome is a significant source of morbidity following pelvic exenteration surgery. It remains poorly defined with research in this field being heterogeneous and of low quality. Furthermore, there has been minimal engagement with patient representatives following pelvic exenteration with respect to the empty pelvic syndrome. 'PelvEx-Beating the empty pelvis syndrome' aims to engage both patient representatives and healthcare professionals to achieve an international consensus on a core outcome set, pathophysiology and mitigation of the empty pelvis syndrome.
METHODS AND ANALYSIS
A modified-Delphi approach will be followed with a three-stage study design. First, statements will be longlisted using a recent systematic review, healthcare professional event, patient and public engagement, and Delphi piloting. Second, statements will be shortlisted using up to three rounds of online modified Delphi. Third, statements will be confirmed and instruments for measurable statements selected using a virtual patient-representative consensus meeting, and finally a face-to-face healthcare professional consensus meeting.
ETHICS AND DISSEMINATION
The University of Southampton Faculty of Medicine ethics committee has approved this protocol, which is registered as a study with the Core Outcome Measures in Effectiveness Trials Initiative. Publication of this study will increase the potential for comparative research to further understanding and prevent the empty pelvis syndrome.
TRIAL REGISTRATION NUMBER
NCT05683795.
Topics: Humans; Consensus; Delphi Technique; Health Personnel; Outcome Assessment, Health Care; Research Design; Treatment Outcome
PubMed: 38316595
DOI: 10.1136/bmjopen-2023-076538 -
Journal of Visceral Surgery Feb 2024
Topics: Female; Humans; Pelvic Exenteration; Ovarian Neoplasms; Retrospective Studies; Neoplasm Recurrence, Local
PubMed: 38310075
DOI: 10.1016/j.jviscsurg.2023.12.004 -
BJA Education Feb 2024
Review
PubMed: 38304069
DOI: 10.1016/j.bjae.2023.11.002 -
Gan To Kagaku Ryoho. Cancer &... Dec 2023A 72-year-old male was transported to our hospital with complaints of heart palpitations and dyspnea since a month earlier and was immobile. Blood examination showed... (Review)
Review
A 72-year-old male was transported to our hospital with complaints of heart palpitations and dyspnea since a month earlier and was immobile. Blood examination showed severe anemia, and colonoscopy revealed circumferential tumors in the rectum and the sigmoid colon. Histopathologic examination revealed the tumors as squamous cell carcinoma of the rectum and adenocarcinoma of the sigmoid colon. Therefore, they were diagnosed as double colorectal cancers. CT and MRI showed that rectal cancer invaded the seminal vesicles and the prostate; therefore, the patient underwent neoadjuvant chemoradiotherapy(oral capecitabine and concomitant radiation therapy: a total dose of 50.4 Gy/28 Fr)followed by total pelvic exenteration. Subsequent specimen pathology revealed a tumor regression grading of Grade 2 for the rectal and sigmoid colon cancers, and both were staged as ypT3N0M0, ypStage Ⅱa. Herein, we report a rare case of double cancer of adenocarcinoma of the sigmoid colon and squamous cell carcinoma of the rectum with a literature review.
Topics: Male; Humans; Aged; Rectum; Colon, Sigmoid; Rectal Neoplasms; Adenocarcinoma; Sigmoid Neoplasms; Carcinoma, Squamous Cell
PubMed: 38303295
DOI: No ID Found -
Rozhledy V Chirurgii : Mesicnik... 2023Bowel obstruction is one of the most common postoperative complications in pelvic surgery. In most cases, adhesive mechanical ileus of the small bowel is the cause. In...
INTRODUCTION
Bowel obstruction is one of the most common postoperative complications in pelvic surgery. In most cases, adhesive mechanical ileus of the small bowel is the cause. In procedures such as Hartmann's resection or abdominoperineal rectal resection, it seems that the large wound area on the pelvic walls and pelvic floor and the dead space after the removed rectum with mesorectum contribute to the ileus condition. The aim of this paper was to identify the risk factors for ileus after selected pelvic procedures and to map the possible ways of prevention and treatment of these complications.
METHODS
We performed retrospective simple analysis of a set of 98 patients who underwent elective abdominoperineal resection of the rectum, pelvic exenteration or Hartmann's resection for rectal cancer between 2017-2022. Postoperative complications were recorded, especially bowel obstruction, and perineal wound or rectal stump healing complications. In all 9 patients, who needed reoperation, we searched for risk factors for ileus known from the literature. We also described the management of ileus.
RESULTS
In the group of 9 patients subjected to detailed analysis, 8 risk factors were most common: male gender, obesity, history of radiotherapy, open surgery, requirement of adhesiolysis in primary surgery, large blood loss, difficult dissection, and impaired healing of the rectal stump/perineum. A total of 8 (88.9%) patients had a combination of 4 or more of the mentioned risk factors.
CONCLUSION
Our results confirm the impact of risk factors known from the literature; furthermore, they indicate a connection with the formation of a dead space in the pelvis and with complications of the rectal stump or perineal wound healing. Some of the risk factors cannot be changed, and current preventive measures cannot completely prevent the formation of adhesions. It is therefore advisable to look for other materials and methods that would ideally limit the formation of adhesions and at the same time fill the dead space and thus separate it from the perineal wound.
Topics: Humans; Male; Rectum; Retrospective Studies; Pelvis; Rectal Neoplasms; Postoperative Complications; Perineum; Intestinal Obstruction; Ileus
PubMed: 38302426
DOI: 10.33699/PIS.2023.102.10.395-401 -
The Journal of Obstetrics and... Apr 2024There have been no reported cases of neuroendocrine carcinoma (NEC) of the cervix with pagetoid spread (Pag-S). A 44-year-old woman came to our department because of...
There have been no reported cases of neuroendocrine carcinoma (NEC) of the cervix with pagetoid spread (Pag-S). A 44-year-old woman came to our department because of abnormal cytology that persisted immediately after a radical hysterectomy for NEC of the cervix. A mapping biopsy in a large area from the vaginal wall to the vulva revealed that synaptophysin/Ki-67-positive tumor cells were scattered within the epithelium in multiple areas, suggesting a wide Pag-S of NEC. Because tumor cells were found beyond the vaginal wall, the anterior pelvic exenteration was performed. Since we could pathologically confirm the complete resection and no distant metastases were detected, no adjuvant therapy was performed. Four years have passed since the initial treatment without any tumor recurrence. It is known that the prognosis of NEC of the cervix that invades beyond the cervix is poor; however, if there is a Pag-S pattern, a radical surgical treatment can be considered.
Topics: Female; Humans; Adult; Cervix Uteri; Uterine Cervical Neoplasms; Neoplasm Recurrence, Local; Carcinoma, Neuroendocrine; Prognosis
PubMed: 38297984
DOI: 10.1111/jog.15895 -
The Medical Journal of Australia Mar 2024
Topics: Humans; Australia; Colorectal Neoplasms; Retrospective Studies; Pelvic Exenteration; Neoplasm Recurrence, Local
PubMed: 38282276
DOI: 10.5694/mja2.52218 -
BMJ Open Jan 2024The surgical treatment for locally advanced or recurrent rectal cancer requires oncological clearance with a pelvic exenteration or a beyond total mesorectal excision...
INTRODUCTION
The surgical treatment for locally advanced or recurrent rectal cancer requires oncological clearance with a pelvic exenteration or a beyond total mesorectal excision (TME). The aim of this systematic review is to explore the safety and feasibility of robotic surgery in locally advanced and recurrent rectal cancer by evaluating perioperative outcomes, oncological clearance rates, and survival and recurrence rates postrobotic beyond TME surgery.
METHODS
The systematic review will include studies published until the end of December 2023. The MEDLINE, EMBASE and Scopus databases will be searched. The screening process, study selection, data extraction, quality assessment and analysis will be performed by two independent reviewers. Discrepancies will be resolved by consensus with a third independent reviewer. The risk of bias will be assessed with validated scores. The primary outcomes will be oncological clearance, overall and disease-free survival, and local and systemic recurrence rates post robotic or robot-assisted beyond TME surgery for locally advanced or recurrent rectal cancer. Secondary outcomes will include perioperative outcomes.
ETHICS AND DISSEMINATION
No ethical approval is required for this systematic review as no individual patient cases are studied requiring access to individual medical records. The results of the systematic review will be disseminated with conference presentations and peer-reviewed paper publications.
PROSPERO REGISTRATION OF THE STUDY
CRD42023408098.
Topics: Humans; Robotics; Robotic Surgical Procedures; Treatment Outcome; Laparoscopy; Systematic Reviews as Topic; Rectal Neoplasms
PubMed: 38272558
DOI: 10.1136/bmjopen-2023-080043 -
Cancers Jan 2024Pelvic exenteration (PE) is one of the most radical surgical approaches. In earlier times, PE was associated with high morbidity and mortality. Nowadays, due to improved...
Pelvic exenteration (PE) is one of the most radical surgical approaches. In earlier times, PE was associated with high morbidity and mortality. Nowadays, due to improved selection of suitable patients, perioperative settings, and postoperative care, patients' outcomes have been optimized. To investigate patients' outcomes and identify possible influencing clinical and histopathological factors, we analysed 17 patients with recurrent vulvar cancer who underwent PE in our department between 2007 and 2022. The median age was 64.9 years, with a difference of 40 years between the youngest and the oldest patient (41 vs. 81 years). The mean overall survival time was 55.7 months; the longest survival time reached up to 164 months. The achievement of complete cytoreduction ( = 0.02), the indication for surgery (curative vs. palliative), and the presence of distant metastases (both = 0.01) showed a significant impact on overall survival. The presence of lymphatic metastases ( = 0.11) seems to have an influence on overall survival (OS) time. Major complications appeared in 35% of the patients. Our results support the existing data for PE in cases of recurrent vulvar cancer; for a group of selected patients, PE is a treatment option with good overall survival times and acceptable morbidity.
PubMed: 38254766
DOI: 10.3390/cancers16020276 -
Annals of Gastroenterological Surgery Jan 2024We report the short/mid-term results of surgery for high-risk locally advanced rectal cancer (LARC) after neoadjuvant chemotherapy (NAC, four courses of...
AIM
We report the short/mid-term results of surgery for high-risk locally advanced rectal cancer (LARC) after neoadjuvant chemotherapy (NAC, four courses of S-1 + oxaliplatin+ bevacizumab) without radiotherapy with the primary aim of ypT0-2.
METHODS
High-risk LARC was defined as cT4b, mesorectal fascia (MRF) ≤1 mm (MRF+), or lateral lymph node metastasis (cLLN+) on high-resolution MRI. The planned 32 cases from April 2018 to December 2021 were all included.
RESULTS
There were 10 patients at cT4b (31.2%), 26 MRF+ (81.3%), and 22 cLLN+ (68.8%). Thirteen (40.6%) underwent NAC after a colostomy for stenosis. NAC was completed in 26 (81.2%) cases. Grade 3 or higher adverse events occurred in six (18.7%). One patient developed progressive disease (3.2%). Eleven were ycT0-3MRF-LLN- (34.3%). Curative-intent surgery was performed on 31, with sphincter-preserving surgery in 20, abdominoperineal resection in nine, total pelvic exenteration in two, and lateral lymph node dissection in 24. Two had R1/2 resection (6.4%). A Grade 3 or higher postoperative complication rate occurred in 3.2%. Pathological complete response and ypT0-2 rates were 12.9% and 45.1%. Three-year disease-free survival rates (3yDFS) for ypT0-2 and ypT ≥3 were 81.2%, 46.6% ( = 0.061), and 3-year local recurrence rates (3yLR) were 0%, 48.8% ( = 0.015). 3yDFS for ycT0-3MRF-LLN- and ycT4/MRF+/LLN+ were 87.5%, 48.0% ( = 0.031) and 3yLR were 0%, 42.8% ( = 0.045).
CONCLUSION
NAC yielded a clinically significant effect in about half of high-risk LARC patients. If NAC alone is ineffective, radiotherapy should be added, even if extended surgery is intended.
PubMed: 38250676
DOI: 10.1002/ags3.12720