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At least 91 records · Page 5Linked to original sources
PubMed1984

[Pelvic exenteration combined with sacral resection for recurrent rectal cancer. The roles of carcinoembryonic antigen and pelvic computed tomography for early detection].

Local recurrence of rectal cancer following abdominoperineal resection is rarely amenable to limited resection. CT study of the pelvis revealed recurrent tumor images in relation to the adjacent pelvic structures. Six patients with deeply invading recurrent lesions were subjected to pelvic exenteration combined with sacral resection. No postoperative deaths were encountered. The postoperative sharp drops of serum CEA levels are useful for judging the adequacy of this procedure. The follow-up status of the 6 patients is as follows, respectively: 16 months dead from pulmonary & hepatic metastasis, 11 months and 9.5 months alive without symptoms but with slightly elevated CEA level, and 5 months, 2 months and 2 weeks alive with no evidence of disease. All patients who were relieved of perineal or sciatic nerve pain are now able to walk without any assistance or trouble. Total en bloc residual pelvic exenteration combined with sacral resection is a reasonable treatment for locally recurrent rectal cancer.

Adult↗
PubMed1992

Pelvic exenteration for the treatment of vulvar cancer.

BACKGROUND: Advanced vulvar cancer can be treated by pelvic exenteration. METHODS: A clinical review of patients treated by exenteration surgery for vulvar cancer was performed. RESULTS: From 1950 through 1989, 19 patients underwent pelvic exenteration for advanced or recurrent squamous cell cancer of the vulva. The mean age was 53 years (median, 50 years; range, 40-74 years). The cumulative 5-year survival was 60%. Fourteen patients had posterior exenteration; 2 had anterior exenteration; and 3 had total exenteration. The survival was significantly influenced by lymph node status. When lymph nodes were not involved, 10 of 14 patients survived, whereas all 5 patients with lymph node involvement died of disease (P = 0.002). When exenteration was performed as primary therapy, 7 of 11 patients survived, whereas 3 of 8 survived when exenteration was performed for recurrent disease (P = 0.4). The extent of vulvar involvement did not influence survival (P = 0.99). There was no mortality, but ten patients had complications, including vesicovaginal fistula (three); stomal hernia (two); abscess (one); stress urinary incontinence (one); deep venous thrombosis (one); conduit leak (one); enterocutaneous fistula (one); and small intestinal obstruction (one). CONCLUSIONS: Acceptable survival for advanced or recurrent vulvar cancer can be achieved with pelvic exenteration, but the presence of metastatic disease to lymph nodes markedly decreases survival.

Adult↗
PubMed1994

Total pelvic exenteration for locally advanced rectal carcinoma.

Total pelvic exenteration was performed in 31 patients (30 males and 1 female) who had rectal cancers involving adjoining pelvic structures. Twenty-nine patients had primary tumors and two had recurrent diseases after previous abdominoperineal resection. Preoperative irradiation was used in nine patients with fixed tumors. When performing the surgical procedure, we also actively employed lateral node dissection to make the operation more radical. Three patients (one with primary tumor and two with recurrent) underwent the exenteration with partial sacrectomy because of the sacral involvement and they all died of local failure within 15 months. The overall 5-year survival rate was 52 percent for all patients and 56 percent for those who had primary tumors. The results suggest that total pelvic exenteration with lateral node dissection should be performed for locally advanced rectal cancer if the tumor is not completely fixed to the pelvic wall and preoperative irradiation should be used to convert a fixed tumor to a resectable one.

Adult↗
PubMed1994

Total pelvic exenteration. A 50-year experience at the Ellis Fischel Cancer Center.

OBJECTIVE: To review a 50-year experience with total pelvic exenteration for treatment of advanced pelvic cancer. DESIGN: Retrospective study with 100% follow-up. SETTING: Cancer hospital. PATIENTS: Two hundred thirty-two patients referred for treatment of advanced pelvic cancer who underwent total pelvic exenteration. MAIN OUTCOME MEASURES: Rates of operative mortality, complications, recurrence, and 5-year survival. RESULTS: The morbidity rate was 45%. The operative death rate was 14% during the 50-year period, but decreased from 16.8% in the first three decades to 10% thereafter. Eighty-nine patients (38%) had recurrences. The overall 5-year survival rate was 42%. CONCLUSIONS: Operative mortality and morbidity have declined over 50 years, largely because of proper patient selection, increasing experience, and advances in perioperative care. Exenteration has a major role in the treatment of advanced pelvic cancer.

Adult↗
PubMed1976

Pelvic exenteration as palliation of malignant disease.

It has been traditional to exclude patients with radiation-recurrent carcinoma of the uterine cervix or other pelvic neoplasms, incapacitating pelvic pain, postirradiation fistulas, hemorrhage, or malodorous draining tumor necrosis from pelvic exenteration if cure of the malignant disease is not achievable. This negative attitude is a direct result of the reported high morbidity, prohibitive mortality, and low salvage rate previously associated with pelvic exenteration, the only acceptable surgical approach to these diseases. A recent experience with eighteen patients who underwent pelvic exenteration for advanced primary or recurrent carcinoma of the cervix, urinary bladder, or rectum has led us to challenge several traditional concepts regarding this operative procedure. We have observed but one operative death and our morbidity has been minimal. This may reflect our belief that an aggressive pelvic lymphadenectomy in those patients with direct visceral involvement from radiation-recurrent carcinoma of the pelvic viscera is not advantageous since no significant survival has ever been documented for patients with pathologic visceral involvement and positive lymph nodes. In addition, significant morbidity has always been associated directly with pelvic lymphadenectomy in the irradiated pelvis, and elimination of this phase of the operation in selected patients with radiation-recurrent carcinoma is indicated. Moreover, the considerable decrease in morbidity and the minimal mortality observed have led us to adopt a very liberal attitude toward preoperative selection criteria, and we regularly now use pelvic exenteration not only for cure but as intentional palliation in selected patients. We strongly believe that elimination of pain, fistulas, pelvic sepsis, hemorrhage, and malodorous areas of tumor necrosis are important for improving the quality of life for both the patient and family.

Aged↗
PubMed1997

[Pelvic exenteration--indications, radical nature and follow-up demonstrated with 33 clinical cases].

From March 1983 to March 1997, 24 posterior pelvic exenterations and 9 total pelvic exenterations were performed in 18 patients with recurrent cancer and 15 patients with primary cancer. In 85%, we saw major complications, 78% in primary operations and significantly higher--96%--in recurrent cancer operations. R0 resections we figured out in 67% of primary operations and 40% of recurrent operations. We saw recurrent cancer in 45% of the patients with a mean follow-up of 18.2 months.

Adult↗
PubMed2004

Pelvic exenteration and sphincter preservation in the treatment of soft tissue sarcomas.

BACKGROUND: Pelvic sarcomas are rare and there are very few effective therapeutic alternatives. A complete resection is considered the main factor associated to a good prognosis, which justifies the employment of a pelvic exenteration (PE) in selected cases. METHODS: Between 1980 and 2000, 96 PE were performed, nine of which were for sarcomas. The clinical characteristics, surgical and anatomopathological aspects and the patients' evolution were described. RESULTS: The median follow-up time was 24 months (ranging from 1 to 57 months). In relation to the sphincters preservation, at least one sphincter was preserved in five patients. There were two post-operative deaths. In the last follow-up, six patients were alive without any evidence of the disease. CONCLUSION: Pelvic exenterations should be performed for the treatment of selected cases of locally advanced pelvic sarcomas. Sphincter preservation may be performed, provided that oncological resection principles are obeyed.

Adult↗
PubMed1994

Total pelvic exenteration with or without sacral resection in patients with recurrent colorectal cancer.

Pelvic recurrence from colorectal cancer produces significant morbidity. Radiation can help palliate the pain produced by this recurrence. Frequently patients with recurrent colorectal cancer will progress to a constant unrelenting pain and obstructive uropathy with sacral and bladder involvement. These patients can be candidates for an aggressive surgical resection with the hope of significant palliation and prolonged survival. From October 1988 to December 1991, six patients had total pelvic exenteration at our institution. Of these six patients, two had en bloc sacral resection at levels S1-S2 and one at S2-S3. Two patients had residual disease at the time of primary surgery, and in the other four patients, recurrence occurred 7 to 48 months after primary resection. One patient died with disease at 7 months, and five patients are alive at 9, 25, 25, 37, and 37 months since the pelvic resection; four have no evidence of disease. The present Karnofsky performance status is 80% or greater in all patients. There were no operative deaths. Of the five living patients, the survival from diagnosis of the primary lesion is 25 to 97 months. Total pelvic exenteration and abdomino-sacral exenteration can produce significant palliation and prolong survival in a selected group of patients with pelvic recurrence from colorectal cancer.

Aged↗
PubMed1996

Sexual adjustment of patients undergoing gracilis myocutaneous flap vaginal reconstruction in conjunction with pelvic exenteration.

BACKGROUND: Although the technique for gracilis myocutaneous vaginal reconstruction was first described in the mid-1970s and has been used in conjunction with pelvic exenteration since that time, there is little available information regarding sexual adjustment after such a procedure. The purpose of this study was to assess the sexual adjustment of women who underwent pelvic exenteration and gracilis myocutaneous vaginal reconstruction at the study institution. METHODS: In a prospective study design, 95 patients were identified who underwent pelvic exenteration and gracilis myocutaneous vaginal reconstruction at the study institution from 1977 through 1989 and a convenience sample was selected of 44 patients who completed a modified version of the Sexual Adjustment Questionnaire (SAQ) when they returned to the gynecologic oncology outpatient clinic for routine follow-up care. A vaginal assessment was also performed by the attending physician. RESULTS: Twenty-one of 40 patients (52.5%) completing the questionnaire reported not resuming sexual activity after surgery; 19 patients reported sexual activity between 1.5 months to 12 years postoperatively. Of the patients who resumed sexual activity, 84% did so within 1 year of surgery. The most common problems noted by patients in adjusting to sexual activity after surgery were self-consciousness about the urostomy or colostomy and being seen in the nude by their partner, vaginal dryness, and vaginal discharge. The mean rank of preexenteration SAQ scores was 66.4, and the mean rank of postexenteration scores was 48.7 (P < 0.0001), demonstrating that sexual adjustment after exenteration was significantly poorer than before the surgery. On the basis of data gathered from a vaginal assessment form, 31 of 44 patients (70.4%) were judged to have a potentially functional neovagina. CONCLUSIONS: Based on the findings of this questionnaire study, sexual adjustment is often significantly impaired in women after pelvic exenteration and gracilis myocutaneous vaginal reconstruction. Future modifications in surgical technique, more realistic patient counseling and aggressive postoperative support will hopefully minimize such problems.

Adaptation, Psychological↗
PubMed1987

Palliative pelvic exenteration--futility revisited.

In a retrospective review of 23 pelvic exenterations performed at Miami Valley Hospital, 8 were considered to be palliative procedures because of pelvic or paraaortic lymph node metastases, pelvic peritoneal involvement, pelvic sidewall extension, or distant spread. Following palliative exenteration, morbidity and mortality were high, survival was low, and quality of life was uniformly poor. With rare exceptions, pelvic exenteration as a palliative procedure should not be deliberately performed.

Evaluation Studies as Topic↗
PubMed1992

[Supralevator pelvic exenteration with simultaneous bowel and urinary reconstruction. Two case reports].

Two male patients underwent supralevator pelvic exenteration, preserving their normal voiding and evacuating function. Case 1 was a 19-year-old man with pineal region tumor, and a metastatic lesion in the bottom of the rectovesical pouch, possibly through the ventriculo-peritoneal shunt. Following supralevator pelvic exenteration, the construction of double pouches, a colonic J pouch and Mainz pouch to the urethra, were performed. Case 2 was a 39-year-old man with bulky retrovesical tumor. He underwent supralevator pelvic exenteration by sigmoid colo-proctostomy and U-pouch to the urethra. Both patients achieved continent except for urinary leakage at night and were able to defecate and urinate voluntarily. Urodynamic study revealed that the pressure in their urinary pouches was low.

Adult↗
PubMed1985

Pelvic exenteration.

Sixty-eight patients at the University of Illinois, Cook County, and the West Side Veterans Administration hospitals underwent pelvic exenteration for advanced pelvic malignancies during the 15-year period from 1969 to 1984. Thirty-two had colorectal cancers, eleven cervical, seven bladder, and six vulvar; in twelve the cancers were in miscellaneous pelvic sites. Forty-five exenterations were done with intent to cure, and twenty-three for palliation of patients with bulky, necrotic tumors that had caused symptomatic fistulae, local sepsis, chronic bleeding, or severe localized pain. The total 30-day postoperative mortality was 4.4% (3/68). The 5-year survival rate of patients who underwent curative exenteration was 33% (median 27 months). Pelvic exenteration appears to be a feasible surgical procedure for a variety of advanced malignancies as well as for palliation of severely symptomatic patients.

Adult↗
PubMed2000

[Pelvic exenteration of advanced gynecological malignacies: a report of 18 cases].

OBJECTIVE: To investigate the role of pelvic exenteration in the treatment of advanced gynecological malignances. METHODS: Eighteen patients with cervical cancer in 8, vulvar cancer in 8, and vaginal cancer in 2, who underwent pelvic exenteration at the Cancer Hospital of Shanghai Medical University between 1970 and 1990 were retrospectively analyzed. RESULT: Median age was 52 years (range 27-65). One woman received surgery of total pelvic exenteration, 10 anterior and 7 posterior exenteration. The 3,5-year survival rates were 72%, 50%, respectively. Postoperative morbidity was 16%, and the surgical mortality was 0%. Bowel obstruction occurred in 2 of 18 cases, one of them was treated surgically. CONCLUSIONS: (1) Patients with advanced central type pelvic neoplasms can be successfully treated with exenteration; (2) The patients should be properly selected prior to and in operation, and the procedures must be performed specifically, particularly in exploration stage.

Adult↗
PubMed2005

[Pelvic exenteration].

OBJECTIVE: Review of literature concerning pelvic exenterative procedures. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, Charles University, Prague. METHODS: Review and critical assessment of published data. CONCLUSION: Pelvic exenterations are standard procedures in oncogynecology which have no alternative in certain indications. The most frequent indications are recurrences or progressions of cervical, vulva or vaginal cancers. Exenterative procedures might be used in primary treatment in some cases of locally advanced tumors. Mortality of current procedures reaches 5% to 10%, early and late postoperative morbidity is frequent (40-60%). Recently explorative laparoscopy is used in preoperative staging to decrease the number of aborted procedures due to distant metastasis or pelvic tumor inoperability. The procedure with high morbidity, causing impairment of quality of life, is justified due to good follow-up results--5-years overall survival is about 50-60%. It should be emphasized that with no treatment in these patients median of survival reaches about 6 months.

Female↗
PubMed2004

Laparoscopic hand-assisted Miami Pouch following laparoscopic anterior pelvic exenteration.

BACKGROUND: To determine the feasibility of a laparoscopic hand-assisted Miami Pouch following a laparoscopic anterior pelvic exenteration. CASE: We performed a laparoscopic hand-assisted Miami Pouch following a laparoscopic anterior pelvic exenteration. The procedure involved resection of the bladder, uterus, ovaries, and upper vagina en bloc and the formation of a "Miami Pouch" for continent urinary diversion. The procedure was successful. The operative time was 6 h. The postoperative course was uneventful. CONCLUSION: Laparoscopic hand-assisted Miami Pouch following laparoscopic anterior pelvic exenteration is feasible.

Adenocarcinoma↗
PubMed1991

Concentrated albumin infusion as an aid to postoperative recovery after pelvic exenteration.

Twenty-eight patients underwent pelvic exenterations for gynecologic malignancies between June 1986 and June 1989. The postoperative fluid and electrolytes were managed by one of two regimens. One group of 10 patients was given concentrated 25% albumin infusion for the first 16 hr after surgery in addition to maintenance intravenous crystalloid solution according to ideal body weight. The second group of 18 patients received only a standard crystalloid solution. The albumin infusion group was found to have a more stable postoperative course as evidenced by less fluid boluses (P less than 0.01), fewer electrolyte bolus requirements (P less than 0.01), and easier management of blood pressure and urine output. There was a 50% decrease in total fluid requirement, a higher mean right atrial pressure (P less than 0.05), and a lower maintenance intravenous fluid rate (P less than 0.01). As a consequence, central hyperalimentation was started earlier (P less than 0.01) and the albumin infusion group left the Intensive Care Unit sooner than the non-albumin infusion group. There was not a single instance of clinical fluid overload with this slow infusion technique. Thus, concentrated albumin infusion was beneficial in the acute fluid management of these difficult patients.

Aged↗
PubMed1998

Results from pelvic exenteration for locally advanced colorectal cancer with lymph node metastases.

PURPOSE: We examined the survival benefit of pelvic exenteration for locally advanced colorectal cancer with lymph node metastases, because this issue remains controversial. METHODS: Medical records of 50 patients who underwent curative pelvic exenteration for colorectal cancer were reviewed retrospectively. Nodal metastases were examined by the clearing method in 29 patients and by the conventional manual method in 21 patients. RESULTS: Invasion to contiguous pelvic organs was present in 40 patients (80 percent) and absent in 10 patients (20 percent). Node metastases were present in 33 patients (66 percent). Operative morbidity and mortality rates were 22 percent (11 patients) and 6 percent (3 patients), respectively. Respective five-year survival rates were 60 and 80 percent in the groups with and without organ invasion (no significant difference). Five-year survival rates in patients with nodal metastases was 54.6 percent but was significantly higher, 82.4 percent, in patients without nodal metastases. Five-year survival in 28 patients with both organ invasion and nodal metastases was 53.6 percent. CONCLUSIONS: Long-term survival was afforded by pelvic exenteration for locally advanced colorectal cancer with nodal metastases.

Colorectal Neoplasms↗