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At least 739 records · Page 41Linked to original sources
PubMed1981

Radical surgery in the management of clear cell adenocarcinoma of the cervix and vagina in young women.

The treatment of clear cell adenocarcinoma of the cervix and vagina in young women has varied widely from one institution to another. Since 1956, 16 such patients have been treated primarily with radical surgery at the University of California, San Francisco. The operations have ranged from radical hysterectomy and bilateral pelvic lymph node dissection with preservation of the ovaries to total pelvic exenteration, depending upon the location and extent of the disease. Vaginal reconstruction has been carried out in most of the patients who required vaginectomy. Eleven of the 16 patients are living and well. The remaining five have died of disease, two of them after relatively long disease-free intervals.

Adenocarcinoma↗
PubMed1988

Absorbable synthetic mesh (polyglactin 910) for the formation of a pelvic "lid" after radical pelvic resection.

Isolation of the abdominal contents from the denuded, potentially infected pelvis after radical pelvic surgery has been advocated. Of the many materials evaluated, omentum is usually chosen. In six patients in whom omentum was unsuitable, we have substituted polyglactin 910 (Vicryl, Ethicon, Sommerville, New Jersey) mesh to form a pelvic "lid." In these patients, omentum was either densely adherent in the upper abdomen because of prior surgery or was removed as part of surgical treatment for recurrent cancer. Vicryl mesh formed a "lid" across the true pelvis. No gastrointestinal complications occurred in these patients. Four patients developed pelvic infections that resolved after surgical drainage and antibiotic therapy. No patients developed peritonitis above the pelvis. No chronic infections have been found in more than 12 to 48 months of follow-up. In this preliminary experience, Vicryl mesh appears to be useful for the formation of a pelvic "lid" after exenterative pelvic surgery when the omentum is unavailable.

Absorption↗
PubMed1990

Interstitial radiotherapy for the treatment of advanced or recurrent vulvar and distal vaginal malignancy.

From March 1, 1985 to April 30, 1988 10 patients with locally advanced primary or recurrent vulvar or distal vaginal malignancy were managed with interstitial radiotherapy with or without teletherapy. One patient died of complications of a total pelvic exenteration for radionecrosis 8 months after completion of radiotherapy. The remaining nine patients were alive at a mean follow-up of 28 months (14 to 50 months). Recurrent disease developed within a bed of severe radionecrosis in two patients at 13 and 47 months after completion of radiotherapy. The remaining seven patients have remained without evidence of recurrent disease. Of the 10 total patients severe radionecrosis developed in six at a median of 8.5 months (6 to 26 months) after radiotherapy. We conclude from our data that the use of interstitial needles, mainly combined with external radiotherapy, for the treatment of locally advanced primary or recurrent vulvar and introital malignancy is highly effective but also highly morbid.

Adult↗
PubMed1988

A comparison between intrarectal ultrasound and CT scanning in staging of experimental rectal tumors.

The purpose of this study was to compare the accuracy of preoperative staging of experimental rectal tumors by digital rectal exam, intrarectal ultrasound (IRUS), and CT scanning with pathologic exam. Rectal tumor masses were induced in 10 mongrel dogs by submucosal injection of 2-3 cc of Freund's complete adjuvant. One week later, the animals underwent digital rectal exam, IRUS, and pelvic CT scans. Pelvic exenteration specimens were submitted for pathologic evaluation. Evaluations and interpretations were done in blinded fashion by independent examiners. The rectal "tumor" was detected in 9 of 10 digital exams, 10 of 10 IRUS exams, and 1 of 10 CT scans. Correct Duke's staging occurred in 70% of digital exams, 90% of IRUS exams, and 10% of CT exams compared to pathological staging. Lymph nodes were detected on pathologic exam in all animals (8.7/animal, range 3-16), on IRUS in all animals (6.4/animal, range 5-13), and in none of the digital or CT examinations. IRUS was significantly more accurate in detecting (P less than 0.0001) and locally staging tumors (P less than 0.0001), and in detecting and localizing lymphadenopathy compared to CT scan. Intrarectal ultrasound is a simple, highly accurate device for assessing depth of wall penetration of rectal tumors and in detecting pararectal lymph nodes and should be considered the preoperative staging procedure of choice for rectal cancer.

Animals↗
PubMed1974

Is positive pelvic lymphadenopathy a contraindication to radical surgery in recurrent cervical carcinoma?

The extent of disease at the time of surgical exploration determines whether radical surgery can be performed in the patient who has a postirradiation cervical cancer recurrence. Contraindications to extirpative surgery includes spread of disease beyond the confines of the removable organs. This includes common iliac and periaortic lymph node metastasis. Some authors have advocated aborting the procedure when pelvic nodes are involved. In a review of 170 patients undergoing radical surgery for cervical cancer recurrence, 25 percent with positive nodes survived 5-yr compared with 36 percent with negative nodes. The finding of positive pelvic lymph nodes in itself should not be the sole reason for abandoning the operative procedure.

Female↗
PubMed1986

The canine laboratory in the training of the oncology fellow.

This report deals with one fellow's experience in the dog lab established to aid in the surgical training of the gynecologic oncology fellow. The first experiment was designed to train the fellow in bowel resection and end-to-end anastomosis, comparing suture and staple techniques. A second study evaluated the physical and biological properties of polyglactin 910 (Vicryl) mesh to determine its applicability in reconstructing the pelvic floor following pelvic exenteration.

Abdominal Muscles↗
PubMed1989

Neovagina constructed from an omental J flap and a split thickness skin graft.

Construction of a neovagina has been an accepted gynecologic procedure for many years. The omental J flap normally used to close off the pelvic inlet after total pelvic exenteration can, with modification, be made into a cylinder for a neovagina. This cylinder is sutured to the introitus and lined with a split thickness skin graft providing a satisfactory and functional vagina.

Adult↗
PubMed1989

Continent urinary diversion in gynecologic oncology.

Pelvic exenteration is a salvage procedure used primarily for recurrent gynecologic carcinoma. Up to the present time, an ileal or colon conduit has been used for urinary diversion and the patient remains incontinent of urine. This is a preliminary report of nine patients with gynecologic carcinoma in whom a continent urinary diversion procedure was performed. A segment of distal ileum, the ascending colon, and part of the transverse colon are used to create the colonic reservoir. The segment of colon is opened along the tenia and folded onto itself. The walls of the ascending and transverse colon are anastomosed to detubularize this segment of bowel and eliminate the transient high pressure of the colon. Surgical staples are used for the anastomosis. The segment of ileum is tapered and three purse-string sutures (2-O silk) are placed at the level of the ileocecal valve to achieve continence. The short segment of ileum is then exteriorized as a stoma through which the patient catheterizes. Antirefluxing, non-tunneled ureterocolonic anastomoses are performed. The anterior wall of the reservoir is closed with absorbable staples. Postoperative urodynamic studies have shown maximum capacity of 750 ml and the area of continence to be at the ileocecal valve where the purse-string sutures are placed. All patients are continent and postoperative radiographs were negative for reflux. Follow-up was 6 to 12 months. The colonic reservoir is a capacious low-pressure system and warrants further clinical trials in patients with gynecologic cancer.

Colon↗
PubMed1991

Induction chemotherapy followed by radical surgery in cervical cancer.

To evaluate the therapeutic potential of cytotoxic therapy in patients with squamous cell carcinoma of the cervix, 28 patients with disease clinically localized to the pelvis were treated with chemotherapy followed by radical pelvic surgery. Treatment consisted of cis-platinum 50 mg/m2, mitomycin C 10 mg/m2, vincristine 1.0 mg/m2, and bleomycin 10 U IM given as a course (over 21 days) of induction chemotherapy followed by radical hysterectomy and pelvic and aortic lymphadenectomy in 26 patients and total pelvic exenteration in 2 patients. The stage distribution of the patients in the study was 4 stage IB, 6 stage IIA, 7 stage IIB, 1 stage IIIA, 11 stage IIIB, and 1 stage IVA. Two patients with stage IIIB cancer were found, at the time of laparotomy, to have carcinomatosis and were excluded from the final evaluation in this study. All patients achieved a clinical and histologic response to chemotherapy. There were 35% complete and 65% partial responses. After chemotherapy, at the time of surgery, 4 patients were found to be histologically free of disease, and the incidence of surgically documented nodal disease after chemotherapy was found to be 32%. There was no significant hematologic or pulmonary toxicity. Induction chemotherapy is well tolerated and may be beneficial in the management of some patients with cervical cancer who are at high risk for failure with conventional treatment.

Adult↗
PubMed2005

[Arterio-ureteral fistula, report of three cases].

On connection with four cases of arterio-uro-enteric fistula in three patients and after a review of the literature, the authors propose to make light on this extremely rare complication describing aetiologies factors and the diagnostic means and therapeutics. Two patients had had a pelvic exenteration with respectively Bricker and Kock pouch. The third patient had had an anterior resection in block with the right deferent duct and right seminal gland. All three received high doses of radiotherapy. These fistulas had appeared by abundant haemorrhages. The surgical operation in urgency had made it possible to treat these fistulas with success in two patients. The other patient had deceased of cataclysmic haemorrhage.

Adult↗
PubMed2006

Synchronous prostate stromal sarcoma and gastrointestinal stromal tumor of rectum: case report and review of the literature.

We report a case of prostate stromal sarcoma with initial presentation of obstructive voiding symptoms. The synchronous rectal gastrointestinal stromal tumor was also finally discovered. The patient underwent pelvic exenteration as the choice of treatment. Synchronous prostate stromal sarcoma and rectal gastrointestinal stromal tumor is an extremely rare disease in the literature view.

Aged↗
PubMedDate not supplied

Metastatic penile cancer in a young Caucasian male: impact of delayed diagnosis.

Penile cancer is an uncommon malignancy in the developed world, with only 1200 estimated cases per year in the United States. This is usually a cancer of older men and often the diagnosis is delayed because of lack of suspicion on the part of the patient or primary care provider. We report a case of penile cancer in a young Caucasian male in whom a delay in diagnosis had a deleterious impact on outcome. We describe and illustrate how, to palliate his symptoms, the patient required a hemipelvectomy plus a total pelvic exenteration. We present this case to alert physicians of the possibility of penile cancer in young Caucasian males as well as to demonstrate the significant morbidity and mortality that can ensue from a delay in diagnosis.

Adult↗
PubMedDate not supplied

Anterior rectal wall gastrointestinal stromal tumor presenting clinically as prostatic mass.

Gastrointestinal stromal tumors (GIST) of the anterior rectal wall can present as a prostatic mass, with concomitant obstructive symptoms. Transrectal biopsies of GIST may be misdiagnosed as primary prostatic sarcomas. We report 3 cases of GIST that were initially characterized as prostatic leiomyosarcomas and treated definitively with pelvic exenteration. The correct diagnosis was possible only after immunohistochemical staining for CD117 and was made retrospectively in 2 of 3 cases. Additional therapy with imatinib (Gleevec, Novartis Pharmaceuticals Corporation, East Hanover, NJ), an inhibitor of CD117 tyrosine kinase activity, treated recurrence in one patient and effected complete remission.

Aged↗