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At least 973 records · Page 54Linked to original sources
PubMed1994

Conservative surgery for recurrent or persistent carcinoma of the cervix following irradiation: is exenteration always necessary?

Between 1960 and 1988, 47 patients had conservative surgery for postradiation recurrent or persistent cervical carcinoma. Forty-two patients with nonmetastatic disease and available follow-up information were divided into 3 groups based on the extent of disease and type of surgical procedure. Group 1 contained 13 patients with smaller tumors prior to radiation (FIGO Ib and IIa), and recurrent or persistent disease confined to the cervix and/or vaginal vault. Group 2 consisted of 20 patients presenting with more advanced disease than those in Group 1, at the time of either radiation or surgery. Surgical resection of disease was accomplished in both Groups 1 and 2 by either radical vaginal or abdominal hysterectomy. The 8 patients in Group 3 required extended Wertheim operations to encompass locally advanced disease involving the bladder base and/or parametrium. One patient could not be categorized. The 5-year estimated relapse-free survivals for each group were 84, 49, and 25%, respectively. The relapse-free survival of Group 1 was significantly better (P = 0.003) than that of Group 3. Major complications occurred in 4 patients belonging to Group 1 (31%), 10 in Group 2 (50%), and 6 (including two treatment-related deaths) in Group 3 (75%). The most common complication was fistula formation in 11 patients (26%). Radical hysterectomy can be offered as an alternative to exenteration in carefully selected patients.

Adult↗
PubMed2002

Explorative laparoscopy prior to exenterative surgery.

OBJECTIVE: The objective of this study was to identify the advantages and limits of laparoscopy for assessment of eligibility for exenterative procedures in patients with gynecologic malignancies. METHODS: Between April 1998 and April 2001, 41 consecutive patients with primary or recurrent gynecologic malignancy underwent explorative laparoscopy to detect eligibility for exenteration. RESULTS: Mean age of patients was 54 years (range, 31-80 years). Twenty out of 41 (48.7%) patients underwent exclusively explorative laparoscopy due to unresectable disease or intraabdominal spread of disease. Median operative time for this cohort of patients was 69.1 min (range, 10-278), median blood loss was 30 cc (range 10-60) and no complications occurred. Based on findings of explorative laparoscopy 21 out of 41 (51.2%) patients were eligible for exenteration. Evaluation of extension of disease was correctly done by laparoscopy and was not corrected at laparotomy. One patient out of 21 (4.76%) had extension of disease missed at both laparoscopy and laparotomy and discovered only at an advanced phase of exenteration. Histology of exenterative specimens confirmed laparoscopic evaluation in 20 out of 21 patients (95.25%). CONCLUSIONS: Laparoscopy proved effective for evaluation of patients who were candidates for exenteration and helped to avoid unnecessary laparotomy in half of the candidate patients.

Adult↗
PubMed2005

Long-term survival after concomitant chemoradiotherapy prior to surgery in advanced cervical carcinoma.

OBJECTIVE: To report the long-term survival of 35 patients who underwent surgery after concomitant chemoradiation for locally advanced cervical cancers. METHODS: From 1988 to 1992, 20 bulky IB-IIB patients and 15 stage III-IVA patients underwent surgery after concurrent chemotherapy (CDDP and 5-FU) and radiotherapy. 26 had a hysterectomy, 8 had an exenteration, 1 had no tumor resection. 21 had a para-aortic lymphadenectomy. Endpoints were recurrence and distant metastasis rates, overall survival (OS) and disease-free survival (DFS) at 5 and 10 years. Analysis included FIGO stage, type of surgery (palliative or curative), response to chemoradiation or para-aortic lymphatic status. RESULTS: Surgery had been only palliative in 6 cases (17.1%). A pelvic control has been achieved in 31 patients (88.6%). Pelvic recurrences occurred after a median interval of 7 months. Distant metastases occurred in 10 patients (28.6%), after a median interval of 20 months. So far, 16 patients have died (45.7%). The 10-year DFS is 56.7% in the whole series. Only the type of surgery significantly affected the OS. Only the para-aortic lymphatic status significantly affected the DFS. CONCLUSION: Associating chemoradiation with curative surgery, we obtained a 10-year DFS of 66.4% (OS 57.7%). Adjuvant surgery may increase the survival as it reduces the risk of local relapse.

Adult↗
PubMed1978

Extended total excision of prostatic adenocarcinoma.

Cases of locally advanced prostatic adenocarcinoma (stages B and C) managed by exenteration or prostatocystectomy were reviewed. Local control and survival rates seem to justify this approach in selected cases, especially when conservative measures, such as hormonal therapy and irradiation, have been exhausted.

Adenocarcinoma↗
PubMed2003

Transsacral exenteration of fixed primary and recurrent anorectal cancer.

BACKGROUND: Posteriorly fixed anorectal cancer is often considered incurable, but may be resectable using transsacral approaches. METHODS: We reviewed 45 patients undergoing transsacral exenteration for this problem since 1983 to determine outcome of such surgery. RESULTS: The group consisted of 38 men and 7 women; 17 had primary tumors, 28 had recurrent cancer: local excision, 1; low anterior resection, 11; or abdominoperineal resection, 16. Thirty-nine had prior XRT. Operative mortality was 4%. Severe pain was relieved in 16 of 22 (72%) patients. Crude recurrence rates are local 22%, local plus distant 11%, distant 16%. Five-year disease-free survival is 31% for primary disease, 32% for recurrence. Median survival is abdominoperineal resection recurrence, 24 months; primary cancer, 30 months; low anterior resection recurrence, 37 months. CONCLUSIONS: Transsacral exenteration relieved pain in 70% of patients with fixed anorectal cancer, and led to long-term survival in 31% to 32%. Prognosis trended toward benefit for recurrence after low anterior resection.

Adult↗
PubMed2001

[More effective exenteration of small pelvis organs in colorectal cancer: is it possible?].

21 exenterations of small pelvis organs were performed from 1991 to 2000 for locally-spread cancer of the rectum. Temporary passage feces and urine before radical operation was performed in 6 patients. 10 patients underwent infralevator and 11 patients--supralevator exenteration of small pelvis organs. Continent cypass of urine was carried out in all the patients (in 2--delayed), and of feces--in 8 (in 2--delayed). Substitution of the urinary bladder was performed in 11 patients, formation of reservoir with "dry" urinostoma--in 10.

Adenocarcinoma↗
PubMed1986

The current role of ultraradical surgery in the treatment of pelvic cancer.

Based on the results of experience accumulated in the past 30 years, exenterative pelvic surgery should be a part of the armamentarium of specially prepared oncologic surgeons. It is most frequently indicated for radiation failures in the treatment of carcinoma of the cervix, although it may be justified as primary treatment of selected cases of stage IV lesions without evidence of dissemination outside the pelvis. It is also justified for postirradiation radionecrosis causing sloughing and fistula, provided adequate relief cannot be offered by simple urinary and fecal diversion. For carcinoma of the rectum and pelvic colon, exenteration has a role in the advanced lesions that appear not to have become disseminated outside the pelvis but that involve contiguous viscera. Reoperation for recurrent carcinoma of the rectum is rarely successful, and this dreaded complication is best avoided by a well-planned and adequate standard first operation, or by the early recognition that a more extended operation is necessary. It is to be hoped that adjuvant radiation therapy, either preoperative or postoperative, or both, may be proved effective in preventing recurrence, especially for lesions below the peritoneal reflection, which is the most frequent site of recurrent disease. Finally, ultraradical pelvic surgery has reached its anatomical and pathologic limit. It only remains for the mortality and survival results to be further improved by continued refinements in the technicalities of the operation and in the judgment and selection of patients for it. Multimodal adjunctive therapy has an emerging role, as does selection of patients for functional preservation and reconstruction. The procedures should continue to be done in institutions where special studies are being conducted and where trained and experienced personnel are available with the necessary ancillary services.

Combined Modality Therapy↗
PubMed1982

Primary chemotherapy in the treatment of children with bladder--prostate tumors in the Intergroup Rhabdomyosarcoma Study (IRS-II).

Twenty-nine children (24, male; 5, female) with non-disseminated rhabdomyosarcomas of the bladder or prostate were treated (1978-1980) by a primary chemotherapy regimen consisting of vincristine, actinomycin D, and cyclophosphamide ("Pulse" VAC), with or without local radiotherapy. During the initial 20 wk of chemotherapy, nine children achieved a Clinical Complete Response (CCR). Three of these are without evidence of disease (NED) and have functional bladders, two following partial cystectomy. Four who achieved a CCR subsequently relapsed or remained biopsy positive, but are at present NED following radiotherapy and anterior exenteration. Two patients who achieved CCR status relapsed and have died of disease. Twelve patients had a Clinical Partial Response (CPR) in less than 20 wk and two others in less than 40 wk. Seven of these are NED with intact bladders following chemotherapy-radiotherapy; and an additional patient is NED following partial cystectomy. Four patients in the CPR group have been treated by exenteration following failure to achieve complete response, and are NED. One patient has died, and one has progressive disease. Six patients had an inadequate response to chemotherapy (NR). Anterior exenteration was carried out in three, and two of these have survived. The overall results in these 29 patients are: (A) alive and disease-free with functional bladders, 11; (B) alive and disease-free following anterior exenteration, 10; and (C) dead or death from tumor anticipated, 8. The function of retained bladders (11) has been satisfactory.

Adolescent↗
PubMed1996

Five-year experience with combined operative and radiotherapeutic treatment of recurrent gynecologic tumors infiltrating the pelvic wall.

BACKGROUND: Whereas 25 to 50% of selected patients with gynecologic tumors who relapse centrally in an irradiated pelvis can be salvaged by exenteration, postirradiation recurrence infiltrating the pelvic side wall generally has been fatal. We have designed the combined operative and radiotherapeutic treatment (CORT) procedure for the treatment of postirradiation recurrence infiltrating the pelvic wall and developed several new techniques for its realization. The aim of the surgery is as follows: (1) total resection of the tumor with only a microscopic margin (R1) at the pelvic wall, preserving the bony pelvis and the neurovascular support of the leg; (2) modulation of the therapeutic index for a second high-dose irradiation of the pelvic wall by transferring autologous tissue from the abdomen or the thigh, and (3) reconstruction of pelvic organ functions lost due to tumor resection. The tumor bed is irradiated postoperatively with brachytherapy through transcutaneous guide tubes implanted at the pelvic wall. METHODS: Between April 1989 and December 1994, we treated 48 patients with postirradiation recurrent or persistent gynecologic malignancies infiltrating the pelvic wall with CORT and followed them prospectively with the following endpoints: tumor control, survival, complications, and quality of life. RESULTS: At a median follow-up of 33 months (range, 3-71 months), the 5-year survival probability calculated with the Kaplan-Meier method was 44%. The overall local control rate was 68%, and 85% in the last 25 patients in the series. The censored severe complication rate at 5 years was 33%. No patient died as a consequence of the treatment. Quality of life was self-assessed with a validated questionnaire by 15 patients without evidence of disease, and was rated with a total of 74% of the maximum score points. Age of the patient, state of resection at the pelvic wall (R1 vs. R2), and recurrent tumor size independently influenced tumor progression after CORT in this series. CONCLUSIONS: CORT appears to be a feasible, innovative treatment with long term survival potential and acceptable quality of life for selected patients with postirradiation gynecologic tumor recurrence infiltrating the pelvic wall. R1 resection of the tumor at the pelvic wall is mandatory; however, the reconstruction options within the pelvis are limited.

Adult↗
PubMedDate not supplied

[Anterior pelvectomy].

A total of 24 patients are presented, suffering with extensive vesical and genital cancers, in whom anterior pelvian exenteration was performed. The global mortality rate was of 16% and the postoperative evolution was very good in the remaining patients. It is considered that this type of intervention, provided that it is correctly performed, in association with an adequate ressuscitation, may have remarkably satisfactory results if we consider the advanced local stage of development of the tumors involved.

Adult↗
PubMed1997

Posterior exenteration through groin incision in a patient with stage III vulvar carcinoma.

During performance of bilateral groin incisions, an abdominal incision and a colostomy has the potential risks of devascularization of the lower abdominal wall and infection. A patient with locally advanced vulvar carcinoma requiring a posterior exenteration is presented. The posterior exenteration was performed by developing an abdominal skin flap from the groin incisions. This approach offers adequate exposure and a unique solution to the potential problems associated with combining an abdominal skin incision with bilateral groin incisions and end-descending sigmoid colostomy. In addition, this approach may be cosmetically more acceptable.

Carcinoma, Squamous Cell↗
PubMed1992

Total exenteration, two or one ostomy.

Total exenterations require fecal and urinary diversions, necessitating ostomies in the anterior abdominal wall. This article was done to explore the possibility of extremely low anastomoses of the intestine to the anal stump, to reduce the number of ostomies to only one for the urinary diversion. Although technically feasible, the long term follow-up evaluation of these patients resulted in us having reservations concerning function.

Anal Canal↗
PubMed1997

New technique of vaginal reconstruction following anterior exenteration.

Vaginal reconstruction is important in sexually active females undergoing anterior exenteration for malignant disease. We describe a technique for vaginal reconstruction used in two women who underwent radical cystectomy that required en bloc removal of the anterior vaginal wall. A polyglycolic acid mesh with a pedicle graft of greater omentum creates the anterior 270 degrees and the apex of the neovagina. The technique is simple and adds to the urologist's armamentarium of reconstructive procedures that improve quality of life following exenterative surgery.

Female↗
PubMed2003

Partial abdominal evisceration, ex vivo resection, and intestinal autotransplantation for the treatment of pathologic lesions of the root of the mesentery.

BACKGROUND: Resection of lesions of the root of the mesentery with established techniques is difficult and at times impossible because of their proximity to the blood supply of the intestine. Damage of the superior mesenteric vessels necessitates resection of the intestine, resulting in short bowel syndrome and intestinal failure. STUDY DESIGN: We describe a surgical technique drawn from our experience in intestinal transplantation in which the root of the mesentery (including the lesion) and the head or the entire pancreas, duodenum, small intestine, and part of the colon are excised en bloc and preserved in a cold solution. Resection of the lesion is performed in a bloodless field ex vivo, and the salvaged intestine is reimplanted in the abdominal cavity. We performed this procedure in four patients, two adult and two pediatric, who had extensive neoplasms of the root of the mesentery. Their underlying diseases were mesenteric fibroma, vascular dysplasia of the root of the mesentery, pancreatic cancer, and desmoid tumor. RESULTS: Local control of the lesions was achieved in all four cases, preserving at the same time enough small intestine to avoid short bowel syndrome. All patients survived the operation and live on enteral nutrition 6 to 49.5 months after the procedure. CONCLUSIONS: The procedure of partial abdominal exenteration, ex vivo resection, and autotransplantation is an extension of our experience with intestinal transplantation. In selected cases, this technique may be useful in the treatment of extensive, otherwise unresectable lesions of the root of the mesentery.

Abdominal Pain↗
PubMed1989

[Results of 108 exenteration operations in advanced gynecologic cancers].

We can now say that in our opinion exenteration is not an operation that is dangerous to life, if the conditions that will be described below are observed and if the indication is interpreted sufficiently narrowly, although during the first few years results had been moderate indeed. Exenteration has since developed so positively that it is now increasingly possible to consider the aspect of preserving the function of the adjacent organs, so that the disadvantages resulting for the patient's own body image and her self-concept and self-appraisal are now relatively acceptable compared to what had been possible previously. Indication for exenteration results from the situation, the ideas and the motivation of the patient, mainly, however, against the background of the characteristic features of the operation described here. Today we can say that even these extensive operations are firmly established in gynaecological oncology if there are extended carcinomas and recurring carcinomas. Hence, I believe it is advisable--at least in central recurring carcinomas--to refer such patients to competent surgical oncological centres before attempting to irradiate (or to irradiate again) the recurring tumour.

Colostomy↗
PubMed1995

Concurrent radiation therapy and chemotherapy in the treatment of primary squamous cell carcinoma of the vulva.

BACKGROUND: Interest in combined modality treatment and in quality of life issues may affect the choice of radical vulvectomy as the treatment of choice in many vulvar carcinomas. To evaluate the potential role of combined radiation and chemotherapy with or without local excision as primary treatment for squamous cell carcinoma of the vulva, the outccomes of 19 patients with this disease treated with combination therapy were reviewed. METHODS: Nineteen patients were treated between September 1987 and October 1992. Fifteen patients had American Joint Committee on Cancer Stage III disease; 4 had Stage II. All had clinically negative inguinal lymph nodes with the exception of two patients who had positive ipsilateral inguinal nodes that were removed before treatment. The patients received 45-50 Gy to the pelvis and inguinal nodes with concurrent chemotherapy that consisted of 5-fluorouracil given as a 96-hour continuous infusion (1000 mg/m2/d) during weeks 1 and 5 of radiation. A single dose of mitomycin-C (10 mg/m2) during the first day of chemotherapy has been used since November 1991. Ten patients were boosted with implants or electrons and 6 others underwent local excision. RESULTS: The median follow-up was 34 months. Responses were determined clinically 1 month after completion of the radiation and chemotherapy. Clinically, complete responses were obtained in 10 patients (53%), partial responses in 7 (37%), and no response in 1; 1 patient progressed during treatment. The combined modality therapy (radiation/chemotherapy/with or without wide local excision) resulted in a local control rate of 74% (14/19). All five treatment failures occurred within 6 months of treatment. Four of these patients were rendered disease free by radical vulvectomy and/or exenteration, for an overall local control rate of 95% (18/19). CONCLUSION: Concurrent radiation therapy and chemotherapy with local excision performed as needed, appears to be a reasonable alternative to radical vulvectomy in patients with primary squamous cell carcinoma of the vulva. Radical surgery remains a viable option for patients in whom primary therapy has failed.

Adult↗
PubMed1992

Radical prostatectomy and exenterative procedures for local failure after radiotherapy with curative intent: comparison of outcomes.

During the last 2 decades 62 patients without evidence of distant disease underwent salvage surgery, including radical prostatectomy in 32, anterior exenteration in 23 and total exenteration in 7. Mean followup was 3.7 years, mean radiation dosage was 6,083 cGy. (range 3,060 to 7,400) and interval from irradiation to surgery was 6 to 98 months (mean 48 months). The 5-year nonprogression and cause-specific survivals for radical prostatectomy patients of 82% and 90%, respectively, were significantly (p = 0.0062) better than for patients having exenterative procedures. Despite the more extensive local procedure for larger tumors used in exenteration, the residual cancer rate was higher and local control was not improved. Median time to progression after radical prostatectomy and exenterative procedures was 7.5 and 1.3 years, respectively. Progression and cancer death were related to aneuploid status and, in particular, to hormonal treatment and its timing, with the best results obtained when adjuvant hormonal treatment was used for nonaneuploid tumors. Complications were more frequent than after primary prostate surgery. Salvage exenterative procedures seem to be of questionable benefit because of rapid disease progression. Prostatectomy, if feasible, appears to be an acceptable treatment for these difficult cases.

Aged↗