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At least 19 recordsLinked to original sources
PubMed1973

Pelvic exenteration.

Pelvic exenteration offers the only possibility for cure in patients who have pelvic recurrence after receiving optimum amounts of irradiation. With improved radiotherapy techniques, the number of patients with isolated central failure is steadily diminishing, but there remains a significant number of patients with recurrent cancer of the cervix after radiation therapy for whom the procedure offers the only chance for life. Each patient must be assessed individually, with the risks of the procedure weighed against the possible benefits. Technical advances continue to reduce the operative mortality and ameliorate the postoperative morbidity associated with pelvic exenteration.

Female↗
PubMed2001

Pelvic exenteration.

Pelvic exenterations are the most extensive surgeries performed for patients with gynecologic cancer, and the surgical team and patients have to be fully aware of the many issues that come into the discussion. This article discusses the history, indications, surgical techniques, and complications of pelvic exenteration.

Female↗
PubMed2002

[Conservative surgery and restoration after pelvic exenteration].

Pelvic exenteration can be proposed to non-metastatic patients with advanced or recurrent pelvic cancer and remains frequently the only potentially curative option in combination with others therapies. Colorectal function preservation and reconstructive procedures are useful to decrease functional and psychologic impact and postoperative morbidity. Technical procedures including urinary diversion, colorectal function preservation, vaginal reconstruction and pelvic filling are described and commented. Specific morbidity is analysed.

Anastomosis, Surgical↗
PubMed2001

[Pelvic exenteration].

Pelvic exenteresis (total, anterior and posterior) is operative procedure reserved for the local advanced malignancies of the pelvis. In the period 1995-2001, we have treated 54 patients (20 male, 34 female) by this procedures. By anterior pelvic exenteresis we have treated 6 females for: Ca vesicae urinary (4 pts). Ca PVU after irradiation therapy (1 patient), Ca urethrae (1 patient). By posterior pelvic exenteresis we have treated 2 females for primary advanced Ca of the rectum. By total pelvic exenteresis we have treated 46 pts (20 male, 26 female): Ca PVU after irradiation therapy (10 females), recidivant Ca PVU (8 females), primary advanced Ca of the rectum (7 male, 1 female), recidivant Ca of the rectum (10 male, 7 female), recidivant Schwanoma (1 male), recidivant Sa stromae endometrii (1 female), recidivant Ca vesicae urinary (1 female). The median survival time of all 54 patients was 24 months. Early postoperative mortality was 18% (10 pts). Twenty patients died with median survival of 18 months (range 4-48 months). Twenty one patients are alive without evidence of disease with median follow up period of 41 months (range 6-60 months). Three patients were lost from follow up. Exenteresis pelvis is very complicate operative procedure and it should be limited to perform only in couple surgical centers.

Adult↗
PubMed1976

Pelvic exenteration for advanced pelvic malignancies.

Our experience of 76 pelvic exenterations for advanced pelvic malignancies is presented, with emphasis on the results and complications. The overall operative mortality rate of 14% is acceptable, and a five-year survival rate of 20% has been achieved. The procedure has a definite role to play in the management of advanced but otherwise localized pelvic malignancies.

Female↗
PubMed2004

Quality of life after pelvic exenteration.

OBJECTIVES: Pelvic exenteration, for gynecological and urological cancer, is an extensive and mutilating procedure. The 5-year survival rate is fairly good (40-60%), but little is known about the long-term quality of life. METHODS: In this retrospective cohort study, the quality of life was assessed using the EORTC QLQ-C30 (version 3.0) and the EORTC QLQ-OV28 questionnaires. RESULTS: Healthy females and those who underwent pelvic exenteration for a gynecological or urological malignancy reported comparable levels of emotional functioning and general quality of life. More physical, sexual, and social problems were, however, noted after exenteration. Younger patients and patients who underwent total pelvic exenteration had the most difficulty in adapting to daily life, disease, and treatment. They also had a worse body image, and the influence of the operation on their sex life was greater compared to other patient groups of this study. CONCLUSION: Despite the immense effect of pelvic exenteration on physical, sexual, and social functioning, women who underwent this procedure reported similar levels of emotional functioning and general quality of life compared to healthy women. Adaptation and the mechanism of response shift presumably play an important role.

Adult↗
PubMed2005

Formation of functional neovagina with vertical rectus abdominis musculocutaneous (VRAM) flap after total pelvic exenteration.

BACKGROUND: Pelvic exenteration may be the only curative option for women with recurrent pelvic malignancies. After total pelvic exenteration, the resultant perineal defect heals slowly if left to do so by secondary intention. Reconstruction with the vertical rectus abdominis musculocutaneous (VRAM) flap brings a generous bulk of healthy tissue into the defect, speeding recovery by facilitating primary healing. METHODS: Six women underwent reconstruction of a neovagina using a vertical rectus abdominis musculocutaneous flap. All 6 had total pelvic exenteration for advanced gynecologic malignancy. Primary diagnosis was cervical carcinoma (n = 3), vulvar carcinoma (n = 1), nonsmall cell vaginal cancer (n = 1), and vaginal melanoma (n = 1). Four patients had received adjuvant radiotherapy preoperatively. RESULTS: All flaps remained 100% viable postoperatively. There were no cases of fistula, infection, or bowel obstruction. Two patients died of cardiovascular arrest postoperatively. The 4 other patients report satisfaction with reconstruction. Three had vaginal intercourse with orgasm. CONCLUSION: The inferiorly based vertical rectus abdominis musculocutaneous flap is a dependable source of tissue for pelvic reconstruction and is the flap of choice in the Division of Plastic Surgery. In addition to facilitating healing, the VRAM flap (neovagina) improves a woman's psychosocial well-being.

Carcinoma↗
PubMedDate not supplied

Pelvic exenteration for advanced pelvic malignancy.

Pelvic exenteration is a demanding, yet potentially curative operation, for patients with advanced pelvic cancer. The majority will present with recurrence after prior surgery and radiotherapy. After exenteration, 5-year survival is 40% to 60% in patients with gynecologic cancer as compared to 25% to 40% for patients with colorectal cancer. Physiologic age and absence of co-morbidities appear to be more important when selecting patients for exenteration than chronological age. Careful pre-operative staging, including either computed tomography (CT) scan or magnetic resonance imaging (MRI), usually will identify patients with distant metastases, extrapelvic nodal disease, or disease involving the pelvic sidewall (which generally precludes surgery). The recent application of intra-operative radiotherapy or postoperative high-dose brachytherapy for patients with more advanced pelvic disease, which may include sidewall involvement, may expand the standard indications for exenteration. However, the intent of this procedure, with or without radiotherapy, should be resection of all tumor with the aim of cure since the place of palliative exenteration is controversial at best. The operative details of exenteration are presented, as are two surgical approaches to composite resection of pelvic structures in continuity with sacrectomy. Filling the pelvis with large tissue flaps, usually a rectus abdominus flap, has decreased morbidity rates, particularly with small bowel complications. Peri-operative mortality is usually 5% to 10%, and significant morbidity occurs in over 50% of patients. Restorative techniques for both urinary and gastrointestinal tracts can diminish the need for stomas and, along with vaginal reconstruction, can significantly improve quality of life for many patients after exenteration. These advances in surgery and radiotherapy help make the procedure a viable option for patients with otherwise incurable pelvic malignancy.

Female↗
PubMed1983

Psychosexual adjustment following pelvic exenteration.

Fifteen pelvic exenteration patients from 2 institutions participated in semistructured interviews and objective assessment to examine postoperative psychologic, social, and sexual functioning. Analyses of variance indicated significant differences between the sexually active and nonactive patients and the patients with a neovagina and those with no vaginal capacity only in the area of sexual functioning, not in psychologic or social adjustment. Descriptive statistics for the entire group of patients provide a view of psychosocial adjustment for the average pelvic exenteration patient. Long after such patients are asymptomatic and clinically free of disease, they appear mildly distressed and depressed. However, these women report active and satisfactory levels of social and free-time activities. Sexual functioning continues as the area of greatest disruption for these patients and, as a group, they resemble severely sexually dysfunctional healthy women. This investigation provides a substantive look at the post-treatment life circumstances of these patients and offers a data base for future investigations.

Adaptation, Psychological↗
PubMed2005

The role of pelvic exenteration for treatment of pelvic malignancy--a nine-year experience.

Pelvic exenteration offers the last chance for some women with gynecological and rectal malignancy. A series of 23 patients who underwent pelvic exenteration for local advanced gynecological and rectal malignancies between 1996 and 2004 were retrospectively reviewed. The exenteration was performed because of vulvar cancer in 14 patients and other pelvic malignancies in nine cases: rectal cancer in four cases, in three cases cervical cancer, in one case ovarian cancer and in one case uterine sarcoma. Nine patients developed major complications of the operative field involving the urinary tract or the wound. Early complications included massive bleeding from the sacral plexus in two cases (one patient died during surgery), acute respiratory distress syndrome (ARDS) in one case and thrombophlebitis in one case. Urinary incontinence was observed in two women as a late complication. Only one patient had a complication connected with the gastrointestinal tract. Twenty-two patients were followed-up. In the group of patients with vulvar cancer five women died after 4-29 months because of recurrence of disease. The nine surviving patients are still being followed-up and are without disease; survival time ranges from 6-74 months. In the group of patients with other malignancies four women died.

Aged↗
PubMed1987

CT evaluation of gracilis myocutaneous vaginal reconstruction after pelvic exenteration.

After pelvic exenteration for cancer, the gracilis muscles, skin, and subcutaneous fat from the inner aspect of both thighs may be raised as a pedicle flap and tunneled under the skin into the pelvic space to create a neovagina. We reviewed nine pelvic CT examinations in six patients to evaluate the CT appearance of this procedure and its complications. Five patients are alive and without complications. One patient died 6 months after surgery and had a small-bowel fistula to the neovagina. Normal CT findings included air in the vaginal canal in six of nine examinations, gracilis muscle atrophy in two patients who had early and late CT studies, and early separation of the anterior and posterior approximation of the flaps in one patient. Abnormal findings were seen in two patients: one had an abscess near the vaginal apex that was drained per vagina; the other had extraluminal air in the retropubic and subcutaneous fatty tissues due to a small-bowel fistula into the vagina.

Adult↗
PubMed2006

Laparoscopic pelvic exenteration for advanced pelvic cancers: a review of 16 cases.

OBJECTIVE: The aim of this study was to retrospectively evaluate, in a series of 16 consecutive patients, the technique, feasibility and oncological safety of laparoscopic anterior exenteration for locally advanced pelvic cancers. STUDY DESIGN: Since August 2003, 16 patients with locally advanced pelvic cancer were considered. All patients were in a good general condition, in the age group of 50-60 years of which 12 had cervical carcinoma and 4 had bladder carcinoma. RESULTS: The median operative time was 180 min. The mean number of harvested pelvic iliac nodes was 14. All margins were tumor-free. The median postoperative hospital stay was 3 days. Three patients had postoperative complications; two had subacute intestinal obstruction and one had ureteric leak. The median follow-up was 15 months. CONCLUSIONS: Our results have demonstrated the feasibility and oncological safety of performing anterior exenteration laparoscopically in advanced pelvic cancer patients with acceptable morbidity. Intermediate-term follow-up validates the adequacy of this procedure.

Feasibility Studies↗
PubMed1989

The role of pelvic exenteration for sarcomatous malignancies.

Pelvic exenteration, although performed most frequently for recurrent squamous cell carcinoma of the cervix and vagina, has been used in selected patients with pelvic sarcoma. Nine patients with various histologic types of sarcoma treated by pelvic exenteration are reported. During this 23-year time period, 46 patients with sarcoma were evaluated for possible exenteration. Patients with embryonal rhadomyosarcoma (sarcoma botryoides) were excluded because these pediatric tumors are now treated with less radical operative procedures, plus radiation and chemotherapy. Six patients had exenteration as primary treatment, and three patients had exenteration as secondary treatment. Four patients developed recurrent disease (mean 5.2 months), and all four died of disease. Five patients were alive at 5 and 10 years, for an absolute survival of 55%. All three patients with mixed mesodermal tumors died of recurrent disease, compared with 83% survival for patients with other sarcoma types. Pelvic exenteration may play a limited but important role in the therapy of pelvic sarcoma.

Adult↗
PubMed1994

Surgical and psychosexual outcome following vaginal reconstruction with pelvic exenteration.

The improved prognosis with pelvic exenterative surgery for gynecologic malignancies has resulted in increasing concern for quality of life. Sexual dysfunction is a common sequel to pelvic exenteration and vaginal reconstruction should be considered in all these patients. This case review assesses our experience with three flap techniques for neovaginal construction. Medical charts were reviewed and survivors interviewed. Fourteen patients had vaginal reconstruction with gracilis myocutaneous (n. = 5), bulbocavernosus (n. = 3) or pudendal thigh fasciocutaneous (n. = 6) flaps at the time of pelvic exenteration. Partial or incomplete necrosis occurred in four (24%) and one (7%) patient had complete flap necrosis bilaterally, followed by an entero-vaginal fistula. Two patients developed recto-vaginal fistula in association with a low rectal reanastomosis (n. = 2) and tumor recurrence (n. = 1). Eight patients, seven of whom agreed to an interview and physical examination, are alive at a median of 15.5 months following pelvic exenteration. Three have stenotic and/or foreshortened vaginas. Two patients are apareunic by choice, four have discontinued vaginal intercourse because of dyspareunia and only one patient has satisfactory coitus. Other problems include vulvar pain (n. = 3), vaginal discharge (n. = 3), neovaginal hair growth (n. = 5) and protrusion of flaps (n. = 3). The functional results in this series are disappointing and better methods of vaginal reconstruction should continue to be developed. Patients undergoing neovaginal reconstruction at the time of pelvic exenteration require careful preoperative counselling and ongoing support after surgery with special attention to sexual dysfunction.

Adult↗
PubMed2004

Cecal pelvic transposition following total pelvic exenteration.

BACKGROUND: Multiple techniques have been utilized in an attempt to prevent small bowel obstructions following total pelvic exenteration. Pelvic transposition of the cecum may be an effective way to reduce the incidence of this serious complication. CASES: We present three women who underwent total pelvic exenteration and cecal pelvic transposition to exclude the small bowel from the "empty pelvis". All three patients did well without any postoperative small bowel complications. CONCLUSION: Cecal pelvic transposition precludes the small bowel from entering the pelvis. This procedure can be performed relatively easily by a gynecologic oncologist experienced with bowel surgery. A larger patient series is needed to assess the efficacy of this previously unpublished procedure.

Adenocarcinoma↗
PubMed1999

Pelvic exenteration for recurrent endometrial cancer.

Pelvic exenteration is generally not considered an operation with curative value for women with recurrent endometrial carcinoma. We reviewed our experience with pelvic exenteration performed in patients with recurrent endometrial adenocarcinoma from 1947 through 1994. A total of 44 patients were identified, with a mean age of 60 years (range 35-69 years). Primary therapy usually consisted of total abdominal hysterectomy with bilateral salpingo-oophorectomy, with most receiving either pre- or postoperative radiotherapy. Prior to exenteration, 10 of 44 (23%) patients had never received any form of radiotherapy. The median interval between initial surgery and exenteration was 28 months (range 2-189 months). The type of exenteration performed was total in 23 patients (52%), anterior in 20 patients (46%), and posterior in 1 patient. Major postoperative complications occurred in 35 patients (80%) and included urinary/intestinal tract fistulas, pelvic abscess, septicemia, pulmonary embolism, and cerebrovascular accident. Median survival for the entire group of patients was 10.2 months. Nine patients (20%) achieved long-term survival (>5 years). Pelvic exenteration for recurrent endometrial cancer is associated with a high operative morbidity and poor overall survival. Although only 20% of patients achieved long-term survival, this procedure remains the only potentially curative option for the few patients with central recurrence of endometrial cancer who have failed surgical and radiation therapy.

Adenocarcinoma↗