A new laparoscopic method of bowel radio-protection before pelvic chemoradiation of locally advanced cervix cancers

Leblanc, Éric; Narducci, Fabrice; Bresson, Lucie; Durand-Labrunie, J.; Taïeb, S.; Vanlerenberghe, Edith; Farré, Isabelle; Nickers, Philippe

doi:10.1007/s00464-014-3533-7

Cited by 5 publications

(3 citation statements)

References 18 publications

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“…Leblanc et al [9] have demonstrated the feasibility of transposing omentum into the pouch of Douglas when undertaking laparoscopic staging for cervical cancer. This increased the distance from uterus to rectum and prevented small bowel descending into the space, thus avoiding high doses from brachytherapy.…”

Section: Radiotherapy Developmentsmentioning

confidence: 98%

Management of toxicities following pelvic irradiation for gynaecological cancers

Fernandes¹,

Bhuva²,

Taylor³

2015

Current Opinion in Oncology

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Section: Radiotherapy Developmentsmentioning

confidence: 98%

Management of toxicities following pelvic irradiation for gynaecological cancers

Fernandes¹,

Bhuva²,

Taylor³

2015

Current Opinion in Oncology

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“…The seeds remained in position during the 6 months, with no seed loss and very little migration of the mesh, so the planned dose could be delivered in more than 80% of the cases. The three animals that did not reach the constraints received 79%, 118%, and 118% of the planned 160 Gy volume, in which the pelvic OAR will need to be moved away from the mesh by epiplooplasty or using expanders [ 23 , 24 , 25 , 26 ]. Furthermore, appropriate measures will be required to limit radiation exposure to the staff.…”

Section: Discussionmentioning

confidence: 99%

Experimental study of pelvic perioperative brachytherapy with iodine 125 seeds (I-125) in an animal model

Brun

Ferron

Filleron

et al. 2018

jcb

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PurposeThe aim of this study is to investigate the feasibility of perioperative I-125 low-dose-rate brachytherapy mesh implantation in pelvic locations in an animal model, before applying it clinically.Material and methodsThe animal model was the Romanov adult ewe. Non-radioactive dummy I-125 seeds were implanted by laparotomy in the pelvic area. Forty-five dummy seeds were placed on a 10 cm² polyglactin mesh to obtain a dose of 160 Gy at 5 mm from the center of each seed. Three CT scans were performed at day 15, day 70, and day 180 after surgery to check the positioning of the mesh for eventual seed migration according to bony landmarks and to perform a 3D theoretical dosimetric study. The experimental study design was based on Simon’s minimax plan with a preliminary analysis of 10 ewes to validate the protocol and a second series of 7 ewes.ResultsAfter the first step, 9 of 10 ewes were investigated. For 8 of 9 animals, the 160 Gy isodose line volume was within 10%, showing feasibility of the procedure and allowing 7 more to be added. At the end of the study, 16 of 17 animals were examined. No seeds loss was observed. The volume difference of the 160 Gy isodose line was within 10% in 13 of 16 ewes between the three CT scans. Twelve out of 16 had a coordinate deviation less than or equal to 10 mm on the three axes between the first and the third scans.ConclusionsThese results show the technical feasibility of the pelvic mesh implantation in ewes. A phase I study for patients with locally advanced or recurrent pelvic tumors amenable to surgery, in combination with surgical resection should be possible.

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“…Other prosthetic-free techniques have been described such as the use of an omental-J flap to fill the pouch of Douglas in women treated for cervical cancer but, in male patients, the lack of a solid organ in the middle compartment of the pelvis -such as the uterusleaves a too large area to fill [26]. The sigmoid has also been used as a hammock fixated to the abdominal wall for treatment of metastatic Ewing's sarcoma but this was heavy surgical procedure with temporary colostomy [27].…”

Section: Tablementioning

confidence: 99%

Laparoscopic closure of the pouch of Douglas by a peritoneal running suture. A minimally invasive and prosthetic-free technique to prevent excessive dose delivery to the small bowel during pelvic irradiation for prostate cancer

Loo

Martínez-Gómez

Khalifa

et al. 2021

Clinical and Translational Radiation Oncology

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Background and purpose: Prostate radiotherapy relies on the delivery of high doses that can be obstructed when a small bowel loop descends in the pelvis. We present a laparoscopic minimally invasive prosthetic-free technique closing the Douglas' pouch with a peritoneal running suture to cordon off the bowel from the pelvis and hence allow optimal irradiation. Materials and methods: Prostate cancer patients referred for radiotherapy and whose planning-CT revealed a bowel loop trapped in the pelvis were proposed the procedure, followed by a new planning-CT. This proof-of-concept study reports postoperative follow-up and dosimetric benefits. Results: The procedure was performed in ten patients (2016-2020) as a same-day surgery for nine. Median operative time was 34 min (range 22-50) and no relevant intraoperative complication occurred. The third patient of the series presented a small bowel hernia through the peritoneal suture at the 15th postoperative day requiring a laparotomic desincarceration without major consequences. Regarding the small bowel, median D1cc (dose to 1 cc) was 65.5 Gy and 55.5 Gy (p = 0.005) before and after procedure. Median V60 (volume receiving 60 Gy) was 10.2 cc and 0.0 cc (p = 0.005). In the immediate vicinity of the small bowel (5 mm), median D1cc was 68.3 Gy and 57.7 Gy (p = 0.005). Radiotherapy was safely delivered to all patients. Conclusion: Laparoscopic closure of the Douglas' pouch by a peritoneal suture is an efficient technique to cordon off inconvenient ectopic small bowel loops. It prevents excessive bowel irradiation and hence facilitates curative prostate radiotherapy. The technique could be applied to other pelvic malignancies.

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A new laparoscopic method of bowel radio-protection before pelvic chemoradiation of locally advanced cervix cancers

Abstract: Although this series is preliminary, this simple procedure, feasible by laparoscopy (or laparotomy), seems effective to prevent recto-sigmoid as well as small bowel from radio-induced complications due to pelvic CRT.

Cited by 5 publications

References 18 publications

Management of toxicities following pelvic irradiation for gynaecological cancers

Management of toxicities following pelvic irradiation for gynaecological cancers

Experimental study of pelvic perioperative brachytherapy with iodine 125 seeds (I-125) in an animal model

Laparoscopic closure of the pouch of Douglas by a peritoneal running suture. A minimally invasive and prosthetic-free technique to prevent excessive dose delivery to the small bowel during pelvic irradiation for prostate cancer

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