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At least 217 records · Page 12Linked to original sources
PubMed1976

Combined therapy to prevent complete pelvic exenteration for rhabdomyosarcoma of the vagina or uterus.

Three children with rhabdomyosarcoma (sarcoma botryoides) of the vagina or uterus were managed by modified radical resection combined with pre- and/or postoperative chemotherapy and high-dose irradiation. This plan of therapy contrasts sharply with the conventional approach: i.e., pelvic exenteration consisting of cystectomy, hystovaginectomy, and oophorectomy, with urinary diversion by ureteroileostomy or ureterosigmoidostomy. Two patients had complete regressions of tumor following preoperative chemotherapy and irradiation. The third patient received no preoperative therapy, but was given postoperative radium implantation, irradiation, and chemotherapy. The surgical approach consisted of hystovaginectomy and oophorectomy without urinary diversion. These patients are free of tumor for 32, 44, and 54 months, respectively. There were no serious toxic reactions to the drugs, nor any significant postoperative urinary tract problems. The results reported here suggest that hystovaginectomy and oophorectomy coordinated with chemotherapy and irradiation is an acceptable alternative to pelvic exenteration in patients with sarcoma botryoides of the vagina or uterus.

Adolescent↗
PubMed1995

Pelvic exenteration in gynecologic oncology: Experience at the Mount Sinai Center, 1975-1992.

Thirty-nine patients underwent pelvic exenteration for gynecologic malignancies at The Mount Sinai Medical Center between 1975 and 1992. Surgical techniques, morbidity, survival, and other variables for patients so treated in two periods, 1975-1984 and 1985-1992, were compared. The primary cancer included squamous cell carcinoma of the cervix, 27; adenocarcinoma of the cervix, 1; squamous cell carcinoma of the vagina, 4; adenocarcinoma of the endometrium, 4; squamous cell carcinoma of the vulva, 2; and adenocarcinoma of the rectum, 1. Median survival was 23.1 months, with a median follow-up of 18 months. Survival was significantly related to status of the lymph nodes (p 0.0004) and surgical margins (p 0.0038). There were two postoperative mortalities, one due to pulmonary embolus and another to myocardial infarction. The ability in the second period analyzed, 1985-1992, to integrate a continent urinary reservoir and supralevator exenteration without colostomy yet not induce increased morbidity or decreased survival, has not been previously reported.

Adult↗
PubMed1994

[Pelvic exenteration for cancer of the uterine cervix (prognostic factors)].

The prognostic factors in 104 patients subjected to pelvic exenterations for cervical cancer recurrent after radiation therapy, at The Oncology Service Hospital General de Mexico, S.S., who survived the surgical procedures with a follow-up for three years or more, are presented here. Results were with statistical significance in the next cases: Patients with 35 years old or less, had a better prognosis when compared with the others: 15/22, 68.1%, vs. 36/82, 43.9%, P = 0.03; clinical reports of tumour localized in cervix, 17/22, 77.2%, vs. infiltration of lateral wall of the pelvis: 11/39, 28.2%, P = 0.008. Pyelographic findings of hydronephrosis or renal exclusion: 2/13, 15.3% vs. normal reports: 9/13, 69.2%, P = 0.01. Infiltration of urinary bladder and or rectal wall: 15/41, 36.5% vs. absence of these: 36/63, 57.1%, P = 0.03; tumour involving myometrium with or without ovarian metastases: 2/15, 13.0% vs. absence of these reports: 49/89, 55.5%, P = 0.03 and the absence of lymph metastatic nodes: 40/68, 58.8% vs. the presence of 3 or more positive lymph nodes: 4/15, 26.6%, P = 0.01. In this series we didn't find differences with statistical significance when compared, the modalities of schemes of radiotherapy, the variety of exenterative procedures and the period of time less or more than a year, between the radiotherapy and the surgery.

Adult↗
PubMed2006

Total pelvic exenteration for primary locally advanced and locally recurrent rectal cancer.

AIMS: To report the role of total pelvic exenteration in a series of locally advanced and recurrent rectal cancers. METHODS: In the period 1994-2004, TPE was performed in 35 of 296 patients with primary locally advanced and recurrent rectal cancer treated in the Daniel den Hoed Cancer Center; 23 of 176 with primary locally advanced and 12 of 120 with recurrent rectal cancer. All but one patient received pre-operative External Beam Radiation Therapy (EBRT). After 1997, Intra Operative Radiotherapy (IORT) was performed in case of a resection margin less than 2 mm. RESULTS: Overall major complication rates were not significantly different between patients with primary and recurrent rectal cancer (26% vs. 50%, p=0.94). The hospital mortality rate was 3%. The 5-year local control and overall survival of patients with primary locally advanced rectal cancer were 88% and 52%, respectively. In patients with recurrent rectal cancer 3-year local control and survival rates were 60% and 32%, respectively. An incomplete resection, preoperative pain and advanced Wanebo stage for recurrent cancer were negative prognostic factors for both local control and overall survival. CONCLUSION: TPE in primary locally advanced rectal cancer enables good local control and acceptable overall survival, thereby justifying the use of the procedure. Patients with recurrent rectal cancer showed a high rate of major complications, a high distant metastasis rate, and a poor overall survival.

Adult↗
PubMed1976

Pelvic exenteration: complications of urinary diversion.

We report complications directly related to urinary diversion among 32 patients who underwent pelvic exenteration for gynecologic malignancy. Eight patients (25 per cent) sustained 10 major complications, including 8 urinary fistulas and 2 fistulas from the entero-enterostomy sites. The frequency of these complications was greater among patients who had had total exenteration than among those who had had anterior exenteration. We attempt to identify factors responsible for these complications and discuss methods for reducing the morbidity related to urinary diversion in these patients.

Female↗
PubMed1979

Pelvic exenteration for advanced rectal carcinoma.

Twelve patients with advanced rectal cancer and no evidence of extrapelvic metastases underwent pelvic exenteration. The operative mortality rate was 8.3 per cent. Determinate 3 and 5 year survival rates of 54 and 37 per cent were achieved. Criteria for the selection of patients and techniques of supravesical urinary diversion are discussed.

Aged↗
PubMed1994

[Current methods of surgical rehabilitation of patients with pelvic exenteration].

An original procedure for supravesical urinary diversion to a small intestine pouch, intended to facilitate urination following pelvic exenteration, is suggested. Post-operative complications are minimized due to formation of a "dry" urinostomy, reduced pressure in the pouch and absence of reflux-pyelonephritis. If required, urine flow can be channeled to the pouch by connecting the sigmoid colon to the anal canal. Said procedure offers optimal advantage of rehabilitation as far as urine channeling is concerned.

Humans↗
PubMed1994

Reconstruction of urinary and gastrointestinal tracts in total pelvic exenteration: experience at Columbia-Presbyterian Medical Center.

OBJECTIVES: To examine the effectiveness of and complications from total pelvic exenteration (TPE) with maintenance of urethral and anal sphincter function for locally invasive tumors of the pelvis. METHODS: A retrospective review of 4 patients who have undergone TPE with urethral and anal sphincter preservation at Columbia-Presbyterian Medical Center in the last 2 years was performed with attention to perioperative morbidity and mortality, disease-free status, and need for further operative procedures. RESULTS: Two patients had colorectal adenocarcinoma, 1 had squamous cell carcinoma of the cervix, and 1 had prostate sarcoma. All had urinary tract reconstruction with orthotopic neobladder creation, and 3 of 4 had primary low rectal anastomoses for gastrointestinal reconstruction. One patient underwent creation of a J rectal pouch. One of 4 patients had received radiation therapy for the disease prior to surgery. There was no operative or perioperative mortality. Two of 4 patients required reoperation, 1 in the immediate postoperative period for repair of a left ureteral stricture, and the other 13 months postoperatively for repair of a rectal-neobladder fistula. With a mean follow-up of 25 months (range, 21 to 43 months), 3 of 4 patients are alive and free of disease. All living patients are continent of urine and 2 of 3 are continent of stool. CONCLUSIONS: Our experience confirms that TPE can be effective in controlling a variety of locally advanced pelvic tumors and can be performed in conjunction with simultaneous genitourinary and gastrointestinal reconstruction with minimal morbidity.

Adenocarcinoma↗
PubMed1994

Pelvic exenteration: a review of the Gateshead experience 1974-1992.

OBJECTIVE: To examine morbidity and survival among women treated by pelvic exenteration for gynaecological malignancy. DESIGN: Retrospective review by analysis of case records. SETTING: Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead, UK. SUBJECTS: Eighty-three consecutive patients referred from within the UK from 1974 to 1992 for initial treatment of advanced gynaecological malignancy or management of recurrent disease following unsuccessful initial therapy. RESULTS: Overall five year actuarial survival was 41%, falling to 36% at 10 years. Serious morbidity was low, and there were only three peri-operative deaths. CONCLUSIONS: For patients with limited options for treatment of advanced primary or recurrent cancer, exenteration offers a reasonable prospect of survival with good quality of life.

Actuarial Analysis↗
PubMed1990

[A successfully treated case of aortouretric fistula associated with pelvic exenteration].

A 64-year-old man was hospitalized for massive bleeding from the cutaneous ureterostomy. He had undergone pelvic exenteration with the ureterostomy for rectal cancer invading the bladder five months previously and retrograde ureteric catheters were inserted bilaterally into the ureters. An aortography revealed a pseudoaneurysm of the abdominal aorta in the region transversed by the left ureter. He was successfully treated by en bloc resection of the aortoureteric fistula and the left ureter and repair of the aorta by Dacron patchplasty. Left nephrectomy was also performed because of pyelonephritis. He has had no signs of cancer recurrence or graft infection five years after this operation.

Aorta, Abdominal↗
PubMedDate not supplied

[The Miles-Thompson-Bricker method of total pelvic exenteration in malignant tumors of the rectum with urinary bladder infiltration].

The radical method of surgical treatment of malignant rectal neoplasms, total pelvic exenteration by Miles-Thompson-Bricker, was introduced in the Clinic for General and Vascular Surgery of Military Medical Academy in October, 1993, 45 years after the first operation of that kind in the world. This method of surgical treatment was indicated in 3% of our patients with malignant neoplasms of the distal part of rectum that infiltrated the urinary bladder. The life of patients with two stomas though not easy, was prolonged.

Adult↗
PubMed1997

[Pelvic exenteration: effects of surgical method on quality of life].

This prospective longitudinal study explores the quality of life of patients who underwent pelvic exenteration (n = 21) with or without reconstructive procedures by standardized questionnaires and semistructured interviews. Quality of life is defined in following categories: physical status, psychosocial issues, medical interaction, marital and sexual problems. At three points in time (preoperatively, 4 and 12 months postoperatively) the quality of life was mostly affected by worries about tumor-progress and not being able to care for oneself. Patients who received reconstructive or preserving procedures felt less restrained in all categories than those without reconstructive surgery although the preoperative situation was not different.

Adaptation, Psychological↗
PubMed2004

Brief report: total pelvic exenteration--A retrospective clinical needs assessment.

This clinical needs assessment retrospectively identified 11 women with a history of gynecologic cancer who had undergone pelvic exenteration within the last 4 years, of whom six were available for interview. All patients agreed to telephone interviews, which lasted approximately 45-60 min and addressed their surgical experience. Seven themes emerged from the interviews: concerns about recovery, complications, ostomies, social support, sexuality, disclosure, and fear. The findings of our needs assessment concur with the existing literature noting decreased sexual interest/activity and difficulties with body image. An improvement in mood and an increase in activities over time postoperatively were noted. We also found reluctance by participants to disclose information about their exenterative procedure.

Adult↗
PubMed2006

Total pelvic exenteration: the Albert Einstein College of Medicine/Montefiore Medical Center Experience (1987 to 2003).

OBJECTIVE: To review the trends, modifications and results of 103 consecutive total pelvic exenterations (TPE) performed at the Montefiore Medical Center and Albert Einstein College of Medicine from 1987 to 2003. METHODS: All patients who underwent TPE from January 1987 to December 2003 were included. The medical record, complications, follow-up, clinical status and demographic information were entered in a database. The procedure performed, the method of urinary diversion, colonic diversion, pelvic floor support and vaginal reconstruction were documented. Surviving patients were surveyed regarding their satisfaction with the urinary diversion, the vaginal reconstruction and their sexual function since the surgery. RESULTS: 103 pts were identified. Indications for TPE were recurrent cancers of the cervix (95), endometrium (2), colon and rectum (5), vulva (1). Overall 5-year survival was 47%. 5-year survival for pts with recurrent cervix cancer was 48%. Six pts (6%) recurred >5 years after the TPE. 14 pts (14%) had ureteral anastomotic leaks (no difference between ileal conduit 9/65 (14%) versus 5/38 (13%) continent conduit (P = 0.92). 34 pts (89%) with continent conduits were "continent." 14 pts (17%) had wound complications. 4 pts (4%) had parastomal hernias. 5/11 (46%) pts who had a low rectal reanastomosis developed recurrence in the pelvis. 21/39 (54%) of pts with continent conduits would choose an ileal conduit if they had the option again. Long-term renal function was similar in pts with ileal and continent conduits. Mesh of any type for pelvic floor reconstruction is associated with infection and bowel/urinary fistulas. VRAM flaps for neovagina fill the pelvic dead space, reduce the risk of fistulas and 20/36 pts (55%) are sexually active. CONCLUSIONS: Our overall 5-year survival is encouraging, and modifications in surgical technique have improved the reconstructive phase. Low rectal anastomoses at TPE adversely affects survival. Many of our pts with continent urinary diversions would not choose this method again. Mesh of any type is associated with sepsis and bowel/urinary fistulas. VRAM for neovagina reduces fistula rate and are functional in >55% of pts. TPE remains a potentially curative option for these pts.

Adult↗