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At least 469 records · Page 26Linked to original sources
PubMed1999

Phase II trial of radical surgery for locally advanced pelvic neoplasia.

BACKGROUND: Reported operative mortality and survival rates following total pelvic exenteration (TPE) for recurrent pelvic neoplasia are now as good as those for many primary treatments. The currently accepted primary treatments for these tumours are, however, still either radiotherapy alone or radiotherapy and chemotherapy. The primary aim of this study was to evaluate the safety and tolerability of TPE and secondarily to ascertain survival after TPE. METHODS: This was a phase II study of 50 patients with locally advanced pelvic tumours who underwent TPE. RESULTS: Thirty-two patients (64 per cent) underwent TPE for recurrent carcinoma of the cervix, seven (14 per cent) for rectal cancer, three (6 per cent) for vulval carcinoma, three (6 per cent) for vaginal carcinoma, two (4 per cent) for prostate cancer and three (6 per cent) for other tumours. The 30-day mortality rate was 8 per cent with an in-hospital mortality rate of 16 per cent. The crude morbidity rate was 62 per cent, with 23 patients (46 per cent) having grade III or IV toxicity. A complete response was achieved in 63 per cent and a partial response in 37 per cent of patients. The overall median survival time was 86 weeks; it was 111 weeks in patients in whom a complete response was achieved. CONCLUSION: The survival and operative mortality rates that are now attainable with TPE are comparable to those achieved with chemoradiotherapy in advanced pelvic neoplasia. TPE should no longer be reserved for salvage therapy and should perhaps be compared with chemoradiotherapy as first-line treatment in a phase III randomized trial in patients with these tumours.

Adult↗
PubMed1986

[Immediate repair of urethroperineal fistulas after abdominoperineal amputation by means of a cutaneo-muscular flap of the gluteus maximus. Apropos of 2 successfully treated cases].

Although a rare complication, the development of a urethro-perineal urinary fistula immediately after abdomino-perineal amputation is a difficult problem to solve. The fragility of the membranous urethra immediately in contact with the exenterated pelvic cavity which takes several weeks to fill in makes any attempt at isolated direct suture very hazardous. Secondary repair is also frequently difficult and the "functional prognosis is far from being always favourable". The major handicap resulting from the perpetuation of this type of fistula has led us to propose an attempt at immediate repair as soon as it is diagnosed with filling of the pelvi-perineal cavity by a cutaneo-muscular flap taken from gluteus maximus. In the two cases in which this treatment was performed, the fistula was cured and a good quality functional result was obtained.

Buttocks↗
PubMedDate not supplied

Construction of a urinary sphincter by means of an electrically stimulated striated muscle: experimental procedure and urodynamic results on canine model.

A canine model of urinary neosphincter using electrically stimulated autologous striated muscle is described. The superior belly of canine sartorius was activated by a pacemaker with an intermittent low frequency stimulation (0.5-1 pulse per sec) during 7 weeks. Then, the muscle graft was passed around the urethra and sutured back on to itself to form a neosphincter. The surgical procedure was easy to perform and with no complication. Urethral pressure profile was performed initially (T0), and when the muscle was in peri-urethral position, before (T1) and during electrical stimulation (T2). The continence parameter readings (maximal urethral closure pressure MUP, functional length FL, continence zone CZ, and continence area CA) increased from T0 to T1, and from T1 to T2. We noted: 1) 28%, 38%, 52%, and 86% increases for the MUP, FL, CZ, and CA respectively from T0 to T1, 2) 10%, 41%, 30%, and 43% increases for MUP, FL, CZ, and CA respectively from T1 to T2. Chronic low frequency stimulation could transform a skeletal fast-twitch type 2 muscle into a slow-twitch fatigue-resistant type 1 muscle. In this study, morphological changes of the stimulated muscle were noted, whereas phenotype was unchanged. This dynamic autologous neosphincter may be a new alternative to the artificial urinary sphincter prosthesis with fewer complications. Further studies are ongoing to evaluate the efficacy of such a neosphincter as continent system for bladder substitution after pelvic exenteration for pelvic cancers.

Animals↗
PubMedDate not supplied

A rare case of primary malignant mesothelioma originating from the rectovaginal tissue.

A 35 year-old female patient with pelvic malignant mesothelioma is described. The patient underwent total pelvic exenteration due to a pelvic tumor. Macroscopically, the resected tumor was located in the rectovaginal lesion with invasion into the rectal and vaginal wall, and around the internal urethral ostium. Light microscopically, the tumor predominantly consisted of sheets of plump round cells with acidophilic cytoplasm, and focally of tumor cells showing papillary growth pattern. The tumor cells showed remarkable cellular pleomorphism, and were both alcian blue and periodic acid-Schiff stain negative. Electron microscopically, these tumor cells had numerous long bush-like microvilli on their surface with increased length/width ratios. Positive staining with epithelial membrane antigen, cytokeratin, and vimentin, and negative staining with the carcinoembryonic antigen and S-100 protein were observed immunohistochemically. Based on these histological and immunohistochemical estimations, the tumor was diagnosed as a primary malignant mesothelioma originating from the rectovaginal tissue. Review of the literature confirmed the rarity of pelvic malignant mesothelioma. The possibilities of the pathogenesis of the tumor include the tumor's arising from the peritoneal remnant in the rectovaginal tissues, or from the epithelium of the secondary Mullerian system, which shares the same ancestry with the peritoneum.

Adult↗
PubMed2000

Modification of the gluteal perforator-based flap for reconstruction of the posterior vagina.

Vaginal reconstruction after pelvic exenteration not only affords significant psychological benefit, it also decreases the morbidity and mortality associated with pelvic exenteration. In irradiated patients filling the surgical defect with healthy, well-vascularized tissue, such as omental flaps, colonic advancements, and myocutaneous flaps, has been shown to decrease the incidence of fistulas, bowel obstructions, infections, and hemorrhage. A novel use of the gluteal perforator-based flap is described in the unique circumstance of posterior pelvic exenteration with sacrectomy.

Female↗
PubMed1987

Preoperative cystoscopic findings in resectable rectal adenocarcinoma.

Forty-nine patients underwent preoperative cystoscopy prior to surgical resection for adenocarcinoma of the rectum. There were 30 men and 19 women ranging in age from 26 to 78 years, with a median age of 59 years. Surgical resections consisted of abdominoperineal resection, posterior exenteration, or total pelvic exenteration. Twenty patients had positive findings on preoperative cystoscopy while 29 had negative findings. Of the 20 patients with positive cystoscopic findings, eight (40%) had either urologic symptoms or abnormal microscopic findings on urinalysis; however, only one of these eight patients had tumor invasion of the bladder wall at cystoscopy, while the remaining seven had associated benign conditions. In the 29 cystoscopy procedures in which findings were negative, only three patients (10%) had urologic symptoms or abnormal results of urinalysis, none of which were secondary to the rectal carcinoma. We conclude that urinary symptoms can be misleading and unreliable when predicting neoplastic involvement of the bladder by carcinoma of the rectum because of the high incidence of associated benign disorders of the bladder. Therefore, cystoscopy does not have a useful role in staging patients undergoing surgery for rectal carcinoma in terms of local tumor extension.

Adenocarcinoma↗
PubMed1993

Combined treatment of pelvic exenterative surgery and intra-operative pelvic hyperthermochemotherapy for locally advanced rectosigmoid cancer: report of a case.

A huge rectosigmoidal cancer which extended into the urinary bladder in a 64-year-old man is herein described. The tumor occupied the pelvic and lower abdominal cavities, while the rectosigmoid was totally obstructed. No hepatic or pulmonary metastasis was evident. The ventral and flank sides of the peritoneum in the right lower abdomen, right common iliac vessels, bilateral ureters, terminal ileum, cecum, ascending colon, and urinary bladder were all directly invaded by the tumor, but the aorta, sacrum, and lower rectum were free of cancer. Consequently, an anterior pelvic exenteration was carried out along with an ileal conduit and a right hemicolectomy. Immediately after the exenteration, intra-pelvic hyperthermochemotherapy was performed using a 46-47 degrees C perfusate containing 40 micrograms/ml of mitomycin C (MMC) and 200 micrograms/ml of cisplatin (CDDP), for 90 min, in an attempt to prevent any further local recurrence. A right hemicolectomy and a permanent colostomy were done simultaneously with the hyperthermia treatment. After an uneventful postoperative course, the patient was prescribed adjuvant chemotherapy, i.e., two administrations of 17 mg/m2 and 21 mg/m2 of MMC, and ten doses of 710 mg/m2 of 5-fluorouracil (5-FU) followed by five doses of 535 mg/m2 of 5-FU. At the time of this writing, the patient is still alive without recurrence at 21 months after surgery.

Adenocarcinoma↗
PubMed1990

Indiana pouch continent urinary reservoir in patients with previous pelvic irradiation.

Little information exists on the use of continent urinary reservoirs in patients with previous pelvic irradiation. We report the use of the Indiana pouch urinary reservoir in ten women with a history of pelvic irradiation for cervical cancer, of whom eight underwent a total pelvic exenteration for recurrent pelvic tumor and two had diversion for radiation-induced vesicovaginal fistula. All ten women achieved daytime continence, with a median time between catheterizations of 4.5 hours and a median pouch capacity of 500 mL. There was no evidence of leakage from the reservoir or significant ureteral reflux or obstruction on postoperative radiographic evaluation. No patient has required reoperation or had significant postoperative complications with the technique described.

Cecum↗
PubMed2006

Perineal hernia after proctectomy: prevalence, risks, and management.

PURPOSE: Perineal hernias are infrequent complications of abdominoperineal operations with estimated historic prevalences (from the era where the perineal wound was left open) ranging from 0.6 to 7 percent. The purpose of this study was to identify the modern prevalence of postoperative perineal hernias, factors that may contribute to their development, and examine the methods of repair. METHODS: The Mayo Clinic patient database (1990-2000) was interrogated for the following data identifiers: incisional hernia, perineal hernia, abdominoperineal resection, proctocolectomy, and partial or total pelvic exenteration. All surviving patients were followed up to December 2005. The retrieved patient data was retrospectively analyzed. RESULTS: Of a total of 3,761 patients who underwent abdominoperineal resection (including nonrestorative proctocolectomy and pelvic exenteration) during the study period, 8 developed a perineal hernia (5 females). The median age at hernia presentation was 76 (range, 69-84) years, representing a median interval of 22 (range, 1-60) months from the original operation. All were smokers (> or =15 pack years) and five had received chemoradiotherapy for their original diagnosis. The commonest prevalence was found in patients who had undergone abdominoperineal resection (5/1,266) or pelvic exenteration (2/1,334). Only 1 of 1,161 patients developed a perineal hernia after proctocolectomy despite most being on perioperative immunosuppression for inflammatory bowel disease. Abdominal exploration and repair was performed in four patients whereas four underwent perineal repair (2 of each with mesh). None have recurred with a median follow-up of 36 (range, 6-60) months. CONCLUSIONS: Perineal hernias are rare complications of abdominoperineal surgery with a more common prevalence after cancer operations. Smoking and chemoradiotherapy, but not corticosteroid immunosuppression, may be factors. The abdominal approach has advantages over the perineal approach, but both are suitable with good medium-term results.

Abdomen↗
PubMed1983

Genitourinary rhabdomyosarcoma.

Rhabdomyosarcoma is the most common soft tissue malignant neoplasm involving the pelvis of children. Debate still exists over whether the best treatment is pelvic exenteration, radiation and chemotherapy or chemotherapy as the cornerstone to treatment, with diminished needs for extensive surgery and prolonged radiotherapy. Contrariwise, there is little debate over the combined treatment modality for paratesticular rhabdomyosarcoma. We have evaluated and treated 19 children with rhabdomyosarcoma, including 17 with pelvic rhabdomyosarcoma and 2 with paratesticular rhabdomyosarcoma. This retrospective study was done to evaluate treatment regimens for patients with genitourinary rhabdomyosarcoma. For patients with pelvic rhabdomyosarcoma the study was divided into 2 series. In an early series 6 of 7 children had a pelvic exenteration with or without chemotherapy. Of these 7 children 3 are well 15 to 27 years following diagnosis. In a later series of 10 children, when chemotherapy was used more commonly, none underwent pelvic exenteration. Of these 10 patients 7 had chemotherapy or chemotherapy and biopsy only. Only 1 child, who presented with stage IV disease, died in this series. Another child with stage III disease had progressive disease despite chemotherapy and subsequent cystoprostatectomy. Thus, of 9 remaining patients 8 are well from 1 to 8 years. It appears that pelvic rhabdomyosarcoma can be treated effectively with chemotherapy, and limited surgery and radiation. Fortunately, pelvic exenteration can now be limited to a select few.

Antineoplastic Agents↗
PubMed2001

[Preliminary experience with the Miami type ileocolonic urinary reservoir in the practice of oncologic gynecology].

OBJECTIVES: For many years we have used both ileal or colon conduits for urinary diversion during pelvic exenteration. Continent urinary reservoirs have replaced ileal and colon conduits as a method of urinary diversion at our institution. The aim of this study was to review the results and complications associated with continent urinary diversion in patients with gynecologic malignancies. METHODS: We reviewed the records of 26 patients who underwent construction of a continent urinary reservoir (Miami pouch) from February 1991 to June 1994 at the Department of Gynecologic Oncology of the National Cancer Institute of Mexico (Instituto Nacional de Cancerología). Twenty-four of these patients had received radiotherapy for gynecologic malignancies. RESULTS: An ileocolonic continent urinary reservoir (Miami pouch) was created in 26 patients, aged 38-81 years, as part of a concurrent anterior or total pelvic exenteration for primary or recurrent gynecologic malignancies (19 pts.), for the relief of a vesicovaginal fistula (3 pts.), hemorrhagic cystitis (2 pts.), or in substitution of an ileal conduit (2 pts.), with follow-up ranging from 2-54 months. Additional procedures performed concurrently with the Miami pouch and pelvic exenteration included low rectal anastomosis (11 pts.), pelvic floor reconstruction (8 pts.), and vaginal reconstruction (4 pts.). The complications associated with the reservoir included incontinence (1 pt.), ureteral strictures (3 pts.), pouch leakage (1 pt.), difficult self-catheterization (4 pts.), and urosepsis and pyelonephritis (6 pts.). One patient developed pouch stones. In this series, 95.6% of the patients were completely continent. No obstruction or reflux was noted in 92.3% of the cases. Nonsurgical management strategies used for reservoir-related complications included percutaneous nephrostomy, intravenous antibiotics, and percutaneous pouch decompression. Reoperation was required in 5 patients: one patient (early) due to a fistula, another patient required reimplantation due to obstruction, one patient with a nonfunctioning kidney underwent nephrectomy, and two patients with stoma stenosis. CONCLUSIONS: The Miami pouch is a low-pressure continent form of urinary diversion. The continence mechanism is easy to construct and the procedure can successfully be accomplished at the time of pelvic exenteration in patients with gynecologic malignancies. The rate of major complications of the Miami pouch is small and the continent urinary diversion can be undertaken with concurrent low rectal anastomosis or vaginal reconstruction.

Adult↗
PubMed2000

Low colorectal anastomosis after radical pelvic surgery: a risk factor analysis.

OBJECTIVE: This study was conducted to analyze our experience with low (8-12 cm above the anal verge) and very low (<6 cm above the anal verge) colorectal resection and primary anastomosis at the time of radical en bloc resection of pelvic malignancies. STUDY DESIGN: A retrospective review of 77 patients undergoing supralevator pelvic exenteration with low colorectal resection and primary anastomosis in our gynecologic oncology service was carried out. Data were obtained from patient medical records and from the tumor registry. Univariate statistical analysis of the data was used. RESULTS: The distribution of primary malignancies in this cohort was as follows: 33 (43%) recurrent or primary cervical carcinomas, 27 (35%) primary or recurrent ovarian carcinomas, 7 (9%) recurrent vaginal carcinomas, 4 (5%) endometrial carcinomas, 3 (4%) colon carcinomas, and 3 (4%) cases of stage IV endometriosis. Forty patients underwent total pelvic exenteration, and 37 patients underwent posterior exenteration. Thirty-six patients in the total pelvic exenteration group had a history of pelvic irradiation. Twelve (30%) of these patients had development of breakdown or fistulas of the anastomosis. Six of the 12 patients (50%) had undergone protective colostomy. Thirty-seven patients underwent posterior exenteration with primary anastomosis for ovarian cancer, endometrial cancer, colon cancer, or endometriosis, and only 1 of these had received pelvic irradiation. This patient did not have a protective colostomy, and a rectovaginal fistula developed. In addition, there were 3 other breakdowns in the posterior exenteration group. Finally, the presence of preoperative ascites did not appear to alter the breakdown rate of the anastomosis among the patients with ovarian cancer who underwent cytoreductive surgery. CONCLUSION: Radical resection of pelvic tissue remains a crucial part of the armamentarium of the gynecologic oncologist. Previous pelvic irradiation appears to be a major risk factor (35% vs 7.5%) for anastomotic breakdown and fistulas, independent of the presence of a protective colostomy. The overall results appear to be better for patients undergoing this procedure as part of a posterior exenteration.

Anastomosis, Surgical↗
PubMed2003

Management of advanced pelvic cancer by exenteration.

AIM: To describe our results in managing locally advanced primary or recurrent pelvic malignancies. METHOD: Investigations included: clinical, laboratory, endoscopic (rectoscopy and colonoscopy) examinations, ultrasound scan, and CT scan or MRI of the abdomen and pelvis, to determine the extent of the pelvic malignancy. A careful explorative laparatomy of abdomen and pelvis was performed, followed by anterior, posterior or total pelvic exenteration. RESULTS: In the period June 1995-Jan 2002, 7 anterior, 2 posterior and 51 total pelvic exenterations were performed in 60 patients, distributed as follows: 28 for rectal cancer (12 primary, 16 recurrent), 20 for cervical cancer (9 primary, 11 recurrent) and 12 for other pelvic malignancies. The median survival time and overall 5-year survival rates were as follows: primary rectal cancer--50 months and 32%; recurrent rectal cancer--31 months and 17%; primary cervical cancer--46.4 months and 41% and recurrent cervical cancer--23.4 months and 16%. During the same period, 559 of our patients were treated for primary or recurrent rectal cancer by different types of straightforward resection. CONCLUSION: Pelvic exenteration is justifiable in cases of locally advanced primary and recurrent malignancies of rectum, cervical cancer and possibly in cases of other pelvic malignancies.

Colorectal Neoplasms↗
PubMed1976

Pelvic exenterative therapy for gynecologic malignancy: an analysis of 70 cases.

During the 10-year period from June 1, 1965 to June 1, 1975 70 patients with gynecologic malignancy were treated with some type of pelvic exenteration at the University of Michigan Medical Center. Total pelvic exenteration was performed in over 75% of the cases. The most recent figures suggest a 3-year and 5-year survival rate of over 60%. The surgical mortality is 1.4%: the hospital mortality is 1.4%. Those patients with squamous cell disease, such as recurrent carcinoma of the cervix, vagina or vulva, have a better prognosis than do those patients with gland cell disease. Regional lymph node involvement gives a bad prognosis. Advances in therapeutic techniques during this 10-year period, including: 1) use of prophylactic antibiotics: 2) transverse abdominal incision; 3) so-called "ski-position" on the operating table; 4) prophylactic compartmentalization of the inferior vena cava; 5) uretero-sigmoid conduit for urinary diversion; 6) peritoneal graft as a "lid" over the pelvic vault' and 7) split-thickness skin graft vaginoplasty as part of the rehabilitation program, are discussed.

Female↗
PubMed1997

Preoperative evaluation of tumor extension in patients with recurrent cervical cancer.

BACKGROUND: Pelvic exenteration is an option in the treatment of locally recurrent cervical cancer. Various preoperative diagnostic procedures in the estimation of tumor invasion of the bladder and rectum or lymphonodal involvement were evaluated. DESIGN: The sensitivity and specificity of cystoscopy, intravenous pyelography, irrigoscopy, rectoscopy, and computed tomography were evaluated by comparing the preoperative findings with the histological result as the 'golden standards'. RESULTS: In the assessment of bladder invasion the sensitivity of cystoscopy, intravenous pyelography and computed tomography was 22.2%, 55.6% and 55.6%, respectively. The overall sensitivity of the three diagnostic procedures was 77.8%. In the assessment of invasion of the rectum irrigoscopy, rectoscopy and CT revealed a sensitivity of 33.3%, respectively. Only 50% of all cases with tumor infiltration of the rectum showed positive results when all three diagnostic procedures were combined. The sensitivity and specificity of computed tomography in the diagnosis of lymphonodal involvement were 75% and 83.3%, respectively. CONCLUSION: We think that there is an obvious necessity for all diagnostic procedures for patient selection prior to pelvic exenteration. However, all these investigations are not conclusive but complement each other. Prior to pelvic exenteration, critical interpretation of all preoperative diagnostic procedures is mandatory, otherwise surgery results in an unintended palliative procedure.

Adult↗
PubMedDate not supplied

Use of polyglactin 910 mesh (Vicryl) in pelvic oncologic surgery.

Various synthetic materials have been shown to be useful surgical adjuncts in shielding the small intestine from pelvic radiation or in creating a new pelvic floor after major radical resections. Promising preliminary results with a polyglactin 910 (Vicryl) mesh in preventing radiation enteropathy prompted the authors to evaluate its clinical usefulness in reconstruction of the pelvic floor. Use of this mesh in pelvic exenterations (five total, one posterior) for advanced or recurrent gynecologic malignancies was associated with one enteroperineal fistula but no pelvic infection. In comparison with other pelvic reconstruction devices, this absorbable mesh significantly reduced intestinal morbidities in pelvic exenterations. This procedure appears to be feasible, reproducible, and safe, especially in patients who have undergone previous irradiation or those with an unsuitable omentum.

Adult↗