Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “PELVIC EXENTERATION”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 631 records · Page 35Linked to original sources
PubMed1998

The rectus abdominis myocutaneous flap: modifications, complications, and sexual function.

BACKGROUND: Vaginal, perineal, and pelvic floor reconstruction is being performed with increasing frequency in conjunction with radical pelvic surgery. Although the vertical rectus abdominis myocutaneous flap is ideally suited to such procedures, little information exists regarding risks or complications associated with it. METHODS: A chart review of all patients who underwent this procedure at two institutions was performed, and the results were compared with existing series. Surviving patients were asked to describe their satisfaction with the procedure and their sexual function. RESULTS: Between 1990 and 1997, 22 patients underwent placement of a rectus abdominis myocutaneous flap for vaginal/pelvic floor reconstruction, 21 (95.5%) at the time of pelvic exenteration. Attachment of the graft was complete in 20 patients (90.9%) and partial in 1 (4.5%), and 1 patient experienced complete loss that resulted in total vaginal stenosis. Four patients (18.2%) developed mild vaginal stenosis that was corrected with dilators. Donor site complications included wound separation (above the fascia) in three patients and one delayed abdominal closure. There were no cases of bowel obstruction, dehiscence, hernia, or death. The only statistically significant identifiable risk factors for graft necrosis included prior abdominal surgery and operative time. Thirteen of 22 (59.1%) of the patients are cancer free (median progression free interval, 42.2 months), 11 (84.6%) of whom reported having had vaginal intercourse since surgery. CONCLUSIONS: The rectus abdominis myocutaneous flap can be safely used with excellent results and acceptable morbidity, and in this series it restored sexual function in the majority of cancer survivors. Because previous abdominal surgery (transverse incisions or colostomy) may compromise blood supply to the flap, alternative sites should be considered in such cases.

Adult↗
PubMed1999

Reresection for local recurrence of rectal cancer.

Local recurrence is one of the major reasons that rectal cancer surgery is unsuccessful. The aim of this study was to investigate the surgical characteristics of patients undergoing reresection for local recurrence of rectal cancer. A total of nine patients were enrolled in this study, six of whom underwent total pelvic exenteration, one, posterior exenteration, one, abdominoperineal resection with sacral resection, and one, lymph node dissection alone. The mean operative time was 8 h 15 min, and the mean operative blood loss was 2 325 ml. Although major postoperative complications occurred in four patients (44%), there were no postoperative or hospital deaths. Lateral lymph node metastasis was detected in all four patients whose lateral lymph nodes were dissected or extirpated at the reresection. Two patients survived for more than 5 years without rerecurrence, and the cumulative 5-year survival rate was 26%. The para-aortic lymph nodes were the most common site of first rerecurrence. The results of this study indicate that patients who undergo reresection for local recurrence of rectal cancer are at high risk of devel-oping lateral or para-aortic nodal metastasis. Nevertheless, reresection may be a therapeutic option for the local recurrence of rectal cancer.

Adenocarcinoma↗
PubMed1996

Transverse colon urinary diversion in gynecologic oncology.

OBJECTIVE: To describe and analyze the outcome of urinary conduits utilizing the transverse colon over an 11-year period. MATERIALS AND METHODS: All patients undergoing a urinary conduit on the gynecologic oncology service from 1983 to 1993 were identified and a retrospective review was conducted. RESULTS: Transverse colon urinary conduits (TCC) were performed in 86 patients. The majority of patients had a history of cervical cancer (81%), and all but one patient had prior pelvic radiotherapy. TCC was performed in conjunction with pelvic exenteration in 47 patients (55%) and alone as palliation for the effects of progressive malignancy in 10 patients (12%). Other indications for conduit construction included urinary fistulas (19%), ureteral or urethral obstruction (7%), conduit revision (5%), overflow incontinence (2%), or intraoperative ureteral injury (1%). Abnormal preoperative renal morphology was common (48%). A total of 165 ureterocolic anastomoses were performed. Ureteral stents and intestinal staplers were used routinely. The perioperative mortality rate was 3%. Loss of renal function occurred in 10 of 165 renal units (6%). Nineteen (22%) patients had partial ureteral obstruction managed by percutaneous nephrostomy or indwelling stents. Conduit reconstruction was undertaken in 7 patients (8%). Renal calculi were noted in 3 patients. Overall median survival was 30 months. CONCLUSION: The complications of TCC are similar to those experienced in other urinary diversions. No distinct advantage to using the transverse colon was observed. Management of progressive ureteral obstruction by conservative methods, such as percutaneous nephrostomy or ureteral stents, was frequent and provided a reasonable alternative to reoperation in the poor operative candidate.

Adult↗
PubMed2002

Pathological findings of gynecologic organs obtained at female radical cystectomy.

PURPOSE: Historically anterior pelvic exenteration has been the recommended treatment for invasive urothelial carcinoma in women undergoing radical cystectomy. We evaluated the pathological features of reproductive organs removed during exenteration to determine the incidence of malignant pathology in these organs and the need for removal. MATERIALS AND METHODS: We reviewed the records of all patients who underwent radical cystectomy between January 1994 and December 2000. Of these 382 patients, we identified 68 females who underwent radical cystectomy for urothelial carcinoma. We reviewed preoperative, operative and pathological findings, including bladder, lymph nodes, uterine and adnexal pathology, in these female patients. RESULTS: Median patient age was 64 years (range 35 to 86). Gynecologic organs were present in 40 of the 68 surgical specimens (59%). The reasons for absent gynecologic pathology were previous hysterectomy in 26 cases and the preservation of organs during orthotopic urinary diversion creation in 2. Malignancy was identified in 3 specimens, including invasive urothelial carcinoma in 2 (5%). In these 2 cases invasion was clearly identified intraoperatively. Low grade stromal sarcoma of the uterus was present in 1 specimen (2%). CONCLUSIONS: In the absence of clinical suspicion radical hysterectomy at cystectomy rarely improves cancer control. Furthermore, secondary malignancies are rare. The functional impact of preserving gynecologic organs is a subject of ongoing study.

Adult↗
PubMed2006

Advantage of the right lateral position compared with the lithotomy position during the perineal procedure in abdominoperineal resection.

BACKGROUND/AIMS: Abdominoperineal resection (APR) is generally performed in the lithotomy position (LT-APR). The aim of this retrospective study was to evaluate the advantage of the right lateral (RL) position during the perineal phase of APR, in extended APR (ext-APR) that needed additional excision of the pelvic organs and sacrococcyx, and in total pelvic exenteration (TPE). METHODS: The present study is based on 50 patients observed from January 1993 to December 2004 (43 with primary rectal malignancy, 7 with recurrent cancer), who had undergone the following surgeries: LT-APR was carried out in 20 patients, RL-APR in 13, LT-ext-APR in 5, RL-ext-APR in 8, LT-TPE in 2 and RL-TPE in 2. Perioperative factors were compared between the LT and RL position in each operative procedure. RESULTS: When RL-APR was compared with LT-APR, operative time (including the time to change the position) and the amount of operative blood loss were significantly less in RL-APR (mean +/- SE = 314 +/- 16 vs. 381 +/- 18 min, p = 0.0156 and 598 +/- 78 vs. 1,160 +/- 171 g, p = 0.0168, respectively). The blood loss and operative time were also significantly less in RL-ext-APR than in LT-ext-APR (1,060 +/- 170 vs. 3,590 +/- 1,270 g, p = 0.0277 and 353 +/- 31 vs. 488 +/- 41 min, p = 0.0219, respectively). The average blood loss and operative time were 4,190 g and 650 min in LT-TPE, and 1,450 g and 609 min in RL-TPE, respectively. CONCLUSION: The RL position during the perineal phase following the abdominal phase in the LT position significantly decreases blood loss and operative time in APR and ext-APR.

Abdominal Wall↗
PubMed2005

Transrectal ultrasound versus magnetic resonance imaging for detection of rectal wall invasion by prostate cancer.

BACKGROUND: This study compared the accuracy of transrectal ultrasound (TRUS) versus magnetic resonance imaging (MRI) in the detection of rectal wall involvement by prostate cancer in patients undergoing salvage total pelvic exenteration (TPE) or cystoprostatectomy. METHODS: We identified 16 patients who underwent TPE and 24 patients who underwent cystoprostatectomy for locally advanced prostate cancer as salvage procedures with palliative intent. Patients were examined by TRUS, MRI, or both within the month preceding surgery. Histologic evidence of rectal involvement with prostate cancer was considered the gold standard diagnostic criterion in patients undergoing TPE. Among patients undergoing cystoprostatectomy, posterior prostatic surgical margins and clinical evidence of rectal wall recurrence during a median follow-up duration of 18.6 months were considered the gold standard. The sensitivity, specificity, and overall accuracy with which TRUS and MRI detected rectal wall involvement were compared. RESULTS: Fifteen (93.7%) of the patients who underwent TPE had histologically-proven rectal wall involvement with prostate cancer. Rectal and perineal recurrence developed 10 months after surgery in 1 (4.1%) patient in the cystoprostatectomy group. The sensitivity, specificity, and overall accuracy of TRUS were: 92.9 (66.1-99.8), 87.0 (66.4-97.2), and 89.2 (74.6-97.0), respectively. The sensitivity, specificity, and overall accuracy of MRI were: 54.6 (23.4-83.3), 100 (76.8-100.0), and 80 (59.3-93.2), respectively. CONCLUSIONS: TRUS is a highly sensitive diagnostic modality for rectal wall involvement in patients with locally advanced prostate cancer. Although MRI is very specific, it cannot reliably rule out rectal involvement in the presence of a positive TRUS.

Aged↗
PubMed1989

[Primary cytoreductive surgery of advanced ovarian cancer with special reference to the significance of bowel resection].

The importance of cf cytoreductive surgery is discussed with special reference to the bowel resection for advanced epithelial ovarian cancer. In the 10.5-year period from January 1978 to June 1988, 134 patients with epithelial ovarian cancer were seen at Toranomon Hospital. Two (15%) out of 13 patients with epithelial ovarian cancer at stage II underwent bowel resection to achieve cytoreduction, 10 (31%) out of 32 at stage III, and 4 (36%) out of 11 at stage IV, respectively. Modified posterior pelvic exenteration was the most common operative procedure among the bowel resections. In this procedure, resection of both sigmoid colon and rectum and end-to-end anastomosis was carried out. Besides bowel resection, all patients at stage II-IV had abdominal hysterectomy, and bilateral salpingo-oophorectomy with or without omentectomy. Comparison of the treatment was by the method of Kaplan-Meier and the Wilcoxon test. The following results were obtained. 1) Five-year survival rate for patients with bowel resection was 60%, compared to 39% for those undergoing operation without bowel resection (p less than 0.05). 2) Two-year survival for patients having residual cancer even after bowel resection was 61%, compared to 28% for those with residual cancer without bowel resection (p less than 0.05). 3) Two-year survival for patients with residual cancer greater than 2 cm was 8%, compared to 62% for those with residual cancer less than 1.9 cm (p less than 0.05). 4) Four patients who died of cancer 15-26 months after the initial treatment including bowel resection spent 65-85% (mean 76%) of the survival period with normal or subnormal activity, against 0-85% (mean 30%) for 6 patients without bowel resection and with the matched survival period of 15-26 months. Also, the former spent 19-33% (mean 27%) of their survival period in the hospital, against 20-67% (mean 39%) by the latter. These results suggest that bowel resection should be encouraged in order to achieve optimal cytoreduction in patients with advanced epithelial ovarian cancer because of its effectiveness in prolonging survival and the inherent benefits for quality of life.

Fallopian Tubes↗
PubMed1999

Rationale for bladder-sparing surgery in patients with locally advanced colorectal carcinoma.

BACKGROUND: Total pelvic exenteration (TPE) with urinary diversion is a standard surgical approach for patients with locally advanced rectal carcinoma. Because only approximately 50% of patients undergoing TPE have tumor involving the bladder, the authors evaluated the feasibility of bladder salvage in this setting. The current study presents the results of a retrospective study of patients with advanced colorectal carcinoma (classification of >/= T3) to formulate criteria for selecting patients for bladder-sparing procedures. METHODS: The charts of 81 patients with rectal carcinoma classified as >/= T3 were reviewed for age, gender, computed tomography (CT) findings, results of intraoperative examination under anesthesia, final pathologic evaluation, urologic complications, local recurrence, and patient survival. RESULTS: Among the 46 patients who underwent TPE, final pathologic evaluation demonstrated tumor involvement of the bladder in 58% of patients. Preoperative identification of a bladder mucosal abnormality accurately predicted bladder involvement in only 57% of the 30 patients who underwent cystoscopy. CT and intraoperative palpation of the bladder individually predicted the final pathologic findings in 69% and 70% of patients, respectively; of the 21 patients in whom both were positive, 90% had bladder involvement. Of the 35 patients (26 females and 9 males) who underwent bladder-sparing procedures, 22 had complete sparing of the bladder, 9 underwent partial cystectomy (5 with ureteroneocystostomy), 4 underwent ureteroneocystostomy alone, and 2 underwent prostatectomy alone. Ninety-four percent of these 35 patients had negative histologic margins. There was no difference in the incidence rate of urinary complications between patients who underwent TPE and those who underwent a bladder-sparing surgery (17% each). The incidence rates of local recurrence (14% vs. 17%) and the 3-year survival rates (49% vs. 39%) did not differ significantly between the 2 groups. CONCLUSIONS: Bladder-sparing surgery to treat patients with locally invasive colorectal carcinoma provides good local control without sacrificing survival. Women, whose reproductive organs act as a natural barrier, and selected men in whom CT and intraoperative evaluation identify only localized involvement of the prostate or bladder appear to be reasonable candidates for bladder-sparing procedures.

Adult↗
PubMed1993

Ultraradical surgery for advanced carcinoma of the vulva: an update.

From July 1, 1955 to March 31, 1989 24 patients with locally advanced vulvar cancer underwent ultraradical resection. Three patients had received prior radiotherapy. Seventeen of the 24 patients underwent posterior exenteration, four underwent anterior exenteration, and the remaining three required a total pelvic exenteration. One patient died 3 months postoperatively of fulminating infection considered to be a complication of the operation. Three other patients experienced serious complications, including postoperative hemorrhage, severe urinary sepsis, and colostomy stoma necrosis. Eleven (46%) of the 24 patients have remained alive without evidence of recurrent cancer for at least 3 years. Of the 10 patients known to have died of recurrent cancer, nine had positive lymph nodes at the time of surgery. It may be reasonable to utilize ultraradical surgery in patients with clearly resectable lesions who have negative or perhaps 1 or 2 microscopically positive regional lymph nodes.

Journal Article↗
PubMed1990

Refinements in vaginal reconstruction using rectus abdominis flaps.

An improved method for vaginal reconstruction after pelvic exenteration or abdominal perineal resection is provided by the distally based rectus abdominis flap. This extended flap carries a skin paddle from the upper abdomen on the rectus abdominis muscle and deep inferior epigastric vascular pedicle. The skin paddle is inversely tubed to form a vaginal pouch and delivered transpelvically to the perineum. In addition to providing a vaginal reconstruction for sexual function, this reconstruction lessens pelvic wound complications in the exenteration patient by filling endopelvic dead space and revascularizing these frequently irradiated wounds. This method provides a neovagina with a single flap and does not involve additional donor sites in the thighs. Transpelvic passage from above not only fills endopelvic dead space better than thigh flaps, but also it allows retention of a vaginal cuff in supralevator resections. Another significant advantage of this reconstruction is its great reliability with minimal incidence of paddle loss. This flap design illustrates a type of flap refinement in which specific flaps can carry tissue from adjacent vascular territories because of anastomotic vessels between the two vascular territories, such as the vascular watershed between the deep inferior epigastric and superior epigastric vessels in this case.

Female↗
PubMed2004

Surgical treatment of locally progressive stage IIIB carcinoma of the cervix: use of the inverted "T" incision.

Stage III carcinoma of the cervix is treated usually, and often effectively, with the combination of radiation and chemotherapy. For tumors locally recurring, without evidence of distant lymphatic or hematogenous spread, the option of pelvic exenteration rises. The described surgical technique derives from soft tissue sarcoma pelvic surgery. It is a lower midline incision extending transversely at its lower end ("reverse T"), which improves the exposure and hence resectability of some of these tumors.

Female↗
PubMed2006

Major complications following exenteration in cases of pelvic malignancy: a 10-year experience.

AIM: To analyze the major complications after exenteration of gynecological and rectal malignancies. METHODS: Twenty-two patients with gynecological malignancy and 6 with rectal malignancy underwent pelvic exenteration (PE) between 1996 and 2005. PE was performed for primary malignancy in 71.4% of cases (vulvar cancer in 13, cancer rectal in 5, cervical cancer in 1 and Bartholin's gland cancer in 1 cases respectively and recurrent malignancy in 28.6% of cases (cervical cancer in 5, ovarian cancer in 1, uterine sarcoma in 1 and rectal cancer in 1 cases respectively). Posterior PE, total PE and anterior PE were most often performed. RESULTS: Major complications in the operative field involving the urinary tract infection or the wound dehiscence occurred in 12 patients (42.9%). Early complications included massive bleeding from the sacral plexus, adult respiratory distress syndrome (ARDS), thrombophlebitis, acute renal failure, urinary bladder dysfunction, ureter damage, re-operation and pulmonary embolus. Urinary incontinence was observed in 2 women as a late complication. In 1 patient a nephrostomy was performed in 1 patient due to extensive hydronephrosis and 1 patient had complications connected with the gastrointestinal tract. The mortality rate was 7%, of which inter-operative mortality accounted for 3.5%. Major complications often occurred in advanced primary vulvar cancer affecting those with recurrent malignancies. CONCLUSION: PE is more beneficial to patients with primary vulvar and rectal cancer than to those with recurrent cancer. Knowledge of the inherent complications and morbidity of PE is essential.

Acute Kidney Injury↗
PubMed2002

Recurrent cervical cancer.

There are limited treatment options for patients with recurrent cervical carcinoma. Because of low response rates and a negligible impact on long-term survival, the use of chemotherapy in patients with unresectable recurrent disease should be considered palliative. Generally, radiation therapy in previously irradiated patients is considered palliative. For patients who develop recurrent disease after definitive surgery who have not received prior radiation therapy, salvage radiation therapy is the treatment of choice. Similarly, patients who have received definitive primary radiation therapy are candidates for surgical resection of their recurrence. However, there are specific criteria for surgical resection. Radical hysterectomy may be an option for the very rare patient with a small (<2 cm) centrally located recurrence in the cervix or vaginal fornices. However, for most patients, pelvic exenteration remains the only therapeutic option that offers the possibility of long-term survival. Patients who are candidates for exenteration are those with central local recurrences that have not extended to the pelvic sidewalls. The introduction of high-dose-rate intraoperative radiation therapy (HDR-IORT) combined with radical surgical resection has widened the scope of patients who may be offered surgery. Patients who in the past may not have been surgical candidates may benefit from radical surgical resection combined with HDR-IORT. All patients who are surgically fit and have undergone previous radiation therapy should be considered for surgical resection for centrally located recurrences. Patients whose recurrences extend close to the pelvic sidewalls should be referred to centers where HDR-IORT is available.

Brachytherapy↗
PubMed2001

[Evaluation and treatment of cervical cancer].

Tumour stage, tumour size and nodal status are the most important prognostic factors in cervical cancer. Treatment of invasive cervical carcinoma consists of radio-surgical combination, exclusive radiation therapy or exclusive surgery in favourable cases. Radical hysterectomy with lymphadenectomy (pelvic +/- para-aortic) is the reference technical surgery in stage IB and II cervical carcinoma. Conservative surgery can be discussed in young patients with stage IB1 disease. Radiotherapeutic treatment is based on a combination of external irradiation and brachytherapy, with concomitant chemotherapy when bad prognostic factors are present. This treatment represents the reference treatment in advanced stages. Total dose, overall treatment time are important prognostic factors of survival and local control. Pelvic exenteration with reconstructive surgery could be discussed in young patients with centro-pelvic recurrence of a cervical carcinoma.

Adult↗
PubMed1991

[Clinical results of total prostatectomy].

Radical surgery was administered to 63 patients with prostatic carcinoma, of whom 48 were put under total prostatectomy, 13 under cystoprostatectomy and 2 under pelvic exenteration. Adjuvant therapy was given in three forms: pretreatment to 31 patients, castration to 44 patients and pelvic lymphadenectomy to 39 patients. The 7 patients in stage A survived without carcinoma. Of the 25 patients in stage B, recurrence was seen in 7 patients but there were no deaths and the 5- and 10-year cumulative survival rates were both 86%. Of the 24 stage C patients, 8 developed recurrence, 4 died with the disease, and the 5 and 10 year cumulative survival rates were 82% and 55% respectively. There were 7 stage D patients, of whom 3 developed recurrence and 2 died, and these patients had a 5 year cumulative survival rate of 86%. The results demonstrated that total prostatectomy with suitable adjuvant therapy is useful for advanced carcinoma as well as clinically early stage carcinoma.

Aged↗