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PubMed1985

Repair of vaginal prolapse and perineal hernia after pelvic exenteration.

Perineal hernias have been a significant complication of pelvic exenteration since the inception of this procedure. A variety of natural and artificial materials have been used to support the small bowel to prevent its descent into the lower pelvis with subsequent hernia and fistula formation. More recently, neovagina construction using gracilis myocutaneous flaps has provided both sexual function and support for the small bowel. A patient is presented who had prolapse of her neovagina and a perineal hernia 12 months after exenterative surgery. A technique to repair this complication is described, and a possible method of preventing it is discussed.

Adult↗

PubMed1979

Urologic complications of pelvic exenteration for gynecologic malignancy.

We reviewed 43 cases of pelvic exenteration for gynecologic malignancies. Particular attention was paid to the postoperative urologic complications encountered in these patients. The major disease process was carcinoma of the cervix. Six patients had early postoperative complications and 2 of these patients died. Nine patients had late postoperative problems caused by urinary tract infections or stones. Nine other patients had problems related to the urinary diversion that necessitated a secondary operation in the majority of the cases and 2 of these patients died. Advantages of the ileal and colon conduits are discussed.

Adult↗

PubMed1981

Pelvic exenteration for vulvovaginal carcinoma.

Between 1964 and 1978, 16 pelvic exenterations were performed for advanced and recurrent vulvovaginal carcinoma. Eight patients had Stage III carcinoma and four had recurrent vulvar carcinoma. Ten patients had involvement of the anus/sphincter, and two had involvement of the proximal half of the urethra. There were four patients with vaginal carcinoma. Two patients with recurrent vaginal carcinoma had bladder/urethral involvement; one patient each with primary vaginal carcinoma had rectovaginal and vesicovaginal septal disease. Seven patients are alive and free of disease--six for more than 5 years and one for 4 years and 4 months. Three patients died, free of disease, one each of cerebrovascular accident, traumatic subdural hematoma, and pulmonary embolus. One patient died on the ninth postoperative day of aspiration pneumonitis. The absolute 5-year survival rate is 54%.

Adult↗

PubMedDate not supplied

Surgical results of total pelvic exenteration for locally advanced colorectal adenocarcinoma.

BACKGROUND/AIMS: Although total pelvic exenteration (TPE) may lead to local tumor control and improved quality of life in patients with locally advanced colorectal cancer, an adequate understanding of prognostic factors, indications and potential complications associated with these procedures is needed. METHODOLOGY: Records for 15 patients, who underwent TPE for colorectal adenocarcinoma at Oita Prefectural Hospital between January 1983 and November 2001, were reviewed, retrospectively. RESULTS: Ten (66.7%) had positive lymphatic involvement, seven (46.7%) had positive vascular involvement, and three (20%) had positive lymph node metastases. Bladder involvement histologically was evident in eight patients (53.3%). With regard to diagnostic assessment of bladder involvement using CT, the sensitivity and specificity were 83.3% and 60%, respectively. Six of 15 patients (40%) developed complications. Overall local recurrence was observed in 6 (40%) of the 15. The cumulative overall 5-year survival rate of the 15 patients in this study was 54.7%. In the univariate analysis, vascular involvement significantly influenced survival. CONCLUSIONS: TPE appears to be relatively safe and effective for treatment of locally advanced colorectal adenocarcinoma. Vascular involvement was recognized as the only reliable prognostic clinicopathological characteristic.

Adenocarcinoma↗

PubMed1989

Gracilis myocutaneous vaginal reconstruction concurrent with total pelvic exenteration.

The gracilis myocutaneous vaginal reconstruction is commonly performed in patients undergoing a total pelvic exenteration. This retrospective review compares the operative and perioperative morbidity in 107 patients who underwent reconstruction with that in 44 patients who did not have reconstruction. With incorporation of the reconstructive procedure, there were no increases in operating time, blood loss, or length of hospitalization. Before 1980, 65% of patients experienced prolapse of the neovagina; in 25% it was severe. The frequency of prolapse has since been decreased to 16% (6% severe) because of several modifications to the initial technique. Modifications have included using smaller flaps, anchoring the neovagina to the levator and retropubic fascia, and, when necessary for mobilization, ligating the neurovascular pedicle. With these modifications, 66% of patients also remained free of wound breakdown or necrosis. The frequency of severe necrosis has decreased from 24% to 13%. The anatomic result of the vaginal reconstructions appears to have been enhanced by these changes in technique.

Female↗

PubMed1975

Pelvic exenteration for vaginal embryonal rhabdomyosarcoma: a review.

The English language literature for the years 1935-1972 was reviewed to assess the effect of pelvic exenteration on vaginal embryonal rhabdomyosarcoma. Twenty-one cases were determined eligible for review. Tumor was confined to the vagina in 8 cases and extended beyond the vagina in 13 cases. Treatment by pelvic exenteration was found to be relatively ineffective means of curing patients with tumor extending beyond the limits of the vagina. Recent evidence from the literature indicates that better results can be obtained by coordinated treatment, ie, surgery, radiation therapy, and/or chemotherapy, than by surgery alone.

Age Factors↗

PubMed1987

Pelvic exenteration: prognostic significance of regional lymph node metastasis.

The members of the Felix Rutledge Society were surveyed to determine their policies concerning pelvic exenteration when regional lymph node metastasis is discovered at the outset of an operation and the resulting survival data. Survival data from the responding members are presented in a summary table. A series of 448 exenterations performed at The University of Texas M. D. Anderson Hospital and Tumor Institute from 1955 to 1984 was reviewed, and the medical records of patients with positive nodes were analyzed for factors that might influence prognosis, such as anatomical site of cancer, histologic type, and location and number of positive nodes. Of the 407 patients whose lymph nodes were studied histologically, 44 had nodal metastasis. Death from recurrent gynecologic cancer and death from all causes were used as end points, and survival rates were calculated according to primary treatment, treatment of recurrent cancer, cancer of the cervix, location of positive nodes, and number of positive nodes. For patients with positive nodes, 36.2% avoided death from recurrent cancer for 3 years, and 26.3% survived for 5 years. We conclude that although the prognosis for patients with positive nodes is poor, some longterm survivals can be achieved. The goal of pelvic exenteration is cure; however, for selected patients, the operation may be justified when it improves the quality of life and extends life.

Female↗

PubMed1989

Pelvic exenteration for recurrent or persistent gynecologic malignancies: a 10-year review of the Memorial Sloan-Kettering Cancer Center experience (1972-1981).

From January 1, 1972 to December 31, 1981, sixty-five patients underwent pelvic exenteration as treatment for recurrent or persistent gynecologic malignancy at Memorial Sloan-Kettering Cancer Center. Cervical carcinoma was the disease most commonly treated by exenteration. The operative mortality of 9.2% represents an improvement over previous reports from this institution. After routine use of prophylactic minidose heparin, no cases of thrombophlebitis or pulmonary embolus occurred postoperatively. A 5-year survival rate of 23% warrants continued use of exenteration in carefully selected patients. The significant mortality and morbidity associated with pelvic exenteration preclude its use as a palliative procedure.

Female↗

PubMed1987

Pelvic exenteration: role of CT in follow-up.

Fifty-five computed tomography (CT) scans of the pelves and abdomens of 33 patients who had undergone pelvic exenteration were reviewed. There were 27 gynecologic and six colorectal malignancies. The interval between surgery and the first CT scan ranged from 2 weeks to 37 months (median, 8 months). CT findings included abnormal fluid collections (33.3%), abnormalities of the neovagina (30.3%) and presacral soft tissues (36.4%), increased hydronephrosis (54.5%), and lymphocysts (6.1%). Tumors recurred in 17 of 33 patients (51.5%) at a median interval of 9 months after surgery and had several CT manifestations. The most common of these was a soft-tissue mass of variable density and shape, but pelvic fluid collections as well as abnormalities of the neovagina and presacral soft-tissue layer were also associated with tumor recurrence. The surgical indications, methods, and potential post-operative complications of pelvic exenteration were reviewed and the role of CT in the follow-up of these patients was emphasized.

Abscess↗

PubMed1984

[Total pelvic exenteration for primary and locally recurrent rectal cancer].

Thirteen patients with advanced carcinoma of the lower colon and no evidence of extrapelvic metastasis were submitted to total pelvic exenteration with urinary diversion. The operative mortality rate was 7.7%. Determinate 5-year survival rate of 40% was achieved. Local recurrence of rectal cancer following abdominoperineal resection is rarely amenable to limited resection. Six patients with deeply invading recurrent lesions had pelvic exenteration combined with sacral resection. This procedure seems a reasonable treatment for palliation and the chance of cure in selected patients. CT examination of the pelvis is very valuable for the early detection and localization of recurrence.

Adult↗

PubMed1989

Pelvic exenteration in clear cell adenocarcinoma of the vagina and cervix.

Pelvic exenteration was performed in 29 of 527 cases of vaginal and cervical clear cell adenocarcinoma (CCA). Exenteration was the initial therapy in 21 cases (1 stage I, 15 stage II, 3 stage III, 1 stage IV, and 1 unknown stage) and was undertaken in 8 cases for central failure after primary radiotherapy. Of the 78 patients with stage II vaginal CCA, the 9 treated with primary exenteration were compared with the 69 who had other modalities of therapy; no significant difference in the survival experience was noted between the two groups. Among the 96 patients with stage II cervical CCA the survival experience was less favorable for those who underwent primary exenteration (n = 5) than for those who were treated with other varieties of therapy (n = 91). Of the 34 patients with central treatment failure, 8 had exenteration and 26 had other forms of therapy. The overall 5- and 8-year actuarial survival rates for the exenteration group (100 and 60%) do not differ significantly from those for the nonexenteration group (71 and 56%). Primary exenteration was used more frequently in the 1970s but has been predominantly reserved for the treatment of recurrent disease during the past decade. Survival statistics after exenteration for central failure are more favorable in cases of vaginal and cervical CCA than in cases of cervical squamous carcinoma.

Adenocarcinoma↗

PubMed1991

Williams' vulvovaginoplasty after supralevator total pelvic exenteration.

Seven patients had delayed Williams' vulvovaginoplasty after supralevator total pelvic exenteration. Of the three patients who died of carcinoma of the cervix (at 2, 5, and 15 months after vulvovaginoplasty), the first died before having a chance to attempt intercourse, but the other two had reported intercourse on at least two occasions after the reconstruction. One of the patients described the experiences as neither pleasant nor unpleasant but stated that her husband seemed satisfied. The other patient described the experience as satisfactory to both herself and her husband. The remaining four patients are alive with no evidence of recurrent disease at 28, 42, 56, and 106 months after operation. Two of these patients have reported entirely satisfactory sexual relations approximating pre-exenteration frequency, but the remaining two have not had sexual relations since surgery. Both give the main reason for this as lack of opportunity. The Williams' vulvovaginoplasty appears to be a reasonable alternative for vaginal reconstruction in patients who will have and especially who have had exenteration. To improve results, other methods of vaginal reconstruction should continue to be evaluated.

Adult↗

PubMed1985

Total pelvic exenteration for advanced carcinoma of the lower colon.

Thirteen patients with advanced carcinoma of the lower colon and no evidence of extrapelvic metastasis were submitted to total pelvic exenteration. Nine of the 13 patients had ureteral urinary diversion by the ileal segment conduit. Three had colonic conduit bladder using the terminal portion of the descending colon. One patient had bilateral uretero colonic anastomosis. The operative mortality rate was 7.7%. Determinate 5-year survival rate of 38.5% was achieved. Histological examinations of the surgical specimen revealed associated abscesses adjacent to the tumor in six cases, although the cancer extended to the bowel wall and adhered to the surrounding structures in all specimens. Total pelvic exenteration assures a better quality of life, lessening of symptoms, disease control and, in selected patients, a cure.

Adenocarcinoma↗

PubMedDate not supplied

[Role of pelvic exenterations in the treatment of cervix cancers. Apropos of 41 surgically treated cases].

The Department of surgical oncology of the Paul-Strauss Cancer Center of Strasbourg (France) reports its experience about pelvic exenterations in recurrent cervix carcinomas. Based on a series of 41 cases (median age: 48.5 years), all patients, but one, have been primarily treated by sole external beam irradiation or surgery combined with radiotherapy. Salvage ultraradical surgical procedures were total (25 cases), anterior (7 cases) and posterior exenterations (9 cases). Overall 5 and 10 years crude survival were 39 and 27.5%, respectively. Advances in surgical procedures, new developments in techniques of pelvic floor reconstruction and improvement in devices of urinary diversions have mainly contributed to a decrease of postoperative morbidity associated with the obtaining of long survivals in selected patients previously treated, in a curative intent, by other therapeutic modalities. The current place of palliative pelvic exenterations and the support of intraoperative radiotherapy are discussed according to recent literature data.

Adult↗

PubMed1984

Pelvic exenteration: a 15-year experience in a general metropolitan hospital.

Between June, 1966, and June, 1981, 92 pelvic exenterations were performed by gynecologic oncologists at Jackson Memorial Hospital/University of Miami Medical Center. The decrease in postoperative morbidity and mortality and the improved 5-year survival rate probably were related to improvement in hospital facilities and more refined surgical techniques. Urinary and gastrointestinal complications occurred with equal frequency during the period of study and were more common in patients who had received previous radiation therapy. On the basis of our experience, recommendations to decrease gastrointestinal and urinary complications further are presented.

Female↗

PubMed2004

Acute renal failure after anterior pelvic exenteration: a case report and review of the literature.

This is a report of a case of advanced cervical carcinoma in a 34-year-old woman treated with anterior pelvic exenteration at the Department of Gynecology of the Medical University in Gdańsk. Despite annual gynecological check-ups, the patient presented with profuse bleeding from the genital tract. IVa cervical carcinoma according to the International Federation of Gynecology and Obstetrics (FIGO) staging was diagnosed. A vesicovaginal fistula was confirmed. In the postoperative period acute renal failure occurred. Twenty-four days after the operation when normal renal parameters had been restored, the patient was transferred to the Department of Radiotherapy for supplementary treatment. Pelvic exenteration offers the last chance for some women with gynecological malignancy and can provide a good chance of long-term survival in carefully selected patients with gynecological cancer.

Acute Kidney Injury↗

PubMed1987

Major morbidity after pelvic exenteration: a seven-year experience.

Thirty-eight patients underwent pelvic exenteration at the University of South Florida during the last seven years. The majority of the operations were performed for recurrent carcinoma of the cervix, and the operative mortality was 5.3%. Twenty-one patients developed major morbidity in the postoperative period, and 11 with complications involving the gastrointestinal or urinary tract required reoperation. Multivariate logistic regression analysis demonstrated a correlation between the amount of pelvic radiation, type of pelvic floor, type of pelvic drain, amount of blood loss, race, and the occurrence of serious postoperative morbidity. Strategies to avoid serious postoperative morbidity are discussed.

Adult↗

PubMed1998

[Urologic reconstruction within the scope of interdisciplinary pelvic exenteration for treatment of invasive tumors of the pelvis].

In radical surgical treatment of primary or recurrent locally advanced pelvic carcinoma involving the bladder, urinary diversion after cystectomy significantly increases the overall morbidity rate. Analyzing 20 patients retrospectively who underwent total pelvic exenteration from 1988-1997, we found that reconstruction by ileal conduit can be performed safely but leaves the patient with a (mostly second) stoma. The advantage of continence with pouch or neobladder reconstruction needs to be weighed up in view of the more demanding and complicating surgical technique, hence it should be reserved for younger, cooperative patients presenting with a favorable long term prognosis.

Adult↗