Continent ileocolonic urinary reservoir (Miami pouch): the University of Miami experience over 15 years

Salom, Emery; Méndez, Luis; Schey, Dana; Lambrou, Nicholas C; Kassira, Noor; Gómez-Marı́n, Orlando; Averette, Hervy E.; Peñalver, Manuel

doi:10.1016/j.ajog.2004.01.023

Cited by 58 publications

(34 citation statements)

References 28 publications

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“…Salvage surgery is extensive and mainly involves the urinary tract (bladder, urethra and ureters) requiring urinary diversion, but interdisciplinary collaboration is a prerequisite. However, mortality rates of up to 11% reported in earlier series may be discouraging [5,6,10,13] . Indeed, complications do occur, especially when taking the 51% of patients who underwent previous radiation therapy into account [5,6,14,15] , but the majority of these complications can be managed conservatively and do not require additional surgery.…”

Section: Discussionmentioning

confidence: 93%

“…NCT00217633). Despite these encouraging results, there are only a limited number of reports on exenterative procedures [5,6,14,15] . The reason for the reluctance to perform radical surgery is unclear.…”

Section: Discussionmentioning

confidence: 99%

“…The increased use of different continent urinary diversions and orthotopic bladder substitutes has led to their application even in irradiated patients. In a study by Salom et al [6] , 82 patients with recurrent gynecological cancer were subjected to some form of exenterative surgery and urinary diversion with a continent ileocolonic urinary reservoir. The most common reservoir-related complications were urinary tract infections (40%), ureteral stricture (20%) and difficulty in self-catheterization (18%).…”

Section: Discussionmentioning

confidence: 99%

“…The literature on pelvic exenteration is sparse, with complication rates for radical exenterative surgery (anterior, posterior or complete) and urinary diversion ranging up to 75% for early and 83% for late postoperative complications [5,6] . The goal of this study was to evaluate if these women profit from this extensive and mutilating surgery and if there is a chance of cure.…”

Section: Introductionmentioning

confidence: 99%

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The Role of Exenterative Surgery and Urinary Diversion in Persistent or Locally Recurrent Gynecological Malignancy: Complications and Survival

Spahn

Weiß²,

Bader³

et al. 2010

Urol Int

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Objective: Treatment options in patients with persistent or locally recurrent cervical cancer are limited. The aim of this study was to determine the chance of cure and associated morbidity following pelvic exenteration. Patients and Methods: Consecutive patients who underwent pelvic exenteration between January 1992 and December 2006 at the University Hospital of Bern or the Karlsruhe Medical Center were evaluated. Time to recurrence, type of exenteration and urinary diversion, pathological stage, postoperative complications and survival were assessed. Results: Initial therapy prior to diagnosis of persistent or locally recurrent disease included radiation therapy in 51%. Anterior exenteration was performed in 37 (86%) and total exenteration in 6 (14%). Half of the women underwent additional procedures. A continent urinary diversion was constructed in 16 and an ileal conduit in 27 patients. Early postoperative complications were generally minor and only 2 patients required surgical intervention. Four intestinal fistulas were successfully treated conservatively. Late complications were mainly tumor-related. Complication rates associated with the urinary diversion were low and there was no difference in complications between continent and incontinent diversions. The overall disease-specific 5-year survival rate after exenteration was 36.5%. Survival correlated significantly with surgical margin status. Conclusion: In patients with persistent or locally recurrent gynecological malignancy of the pelvis, exenteration is a viable option with long-term survival in over one third of patients. Continent urinary diversion did not show higher complication rates than an ileal conduit and should be considered even in irradiated patients. This may be of greater significance in younger patients in whom an intact body image can play an important role in quality of life.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Role of Exenterative Surgery and Urinary Diversion in Persistent or Locally Recurrent Gynecological Malignancy: Complications and Survival

Spahn

Weiß²,

Bader³

et al. 2010

Urol Int

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“…12 The complication rates for radical exenterative surgery can be as high as 75% for early and83% for late complications. [13][14][15] Systemic salvage chemotherapyis mainly considered palliative due to low response rates and negligible impact on long term survival. In a literature review by Pectasides et al 16 , the response rates to single agent chemotherapy ranged between 7-68% with the highest rates reported with cisplatinum.…”

Section: Discussionmentioning

confidence: 99%

Salvage Stereotactic Body Radiosurgery in the Management of Recurrent Gynecological Cancer

Yazıcı¹

2013

UHOD

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Local tumor persistence in the pelvis is the major cause of death in patients with recurrent gynecological cancer. Pelvic exenteration has been the only treatment option providing a chance for cure in selected patients. The aim of this study is to analyze the efficacy of stereotactic body radiosurgery (SBRS) in patients with recurrent gynecological cancer. Sixteen patients treated with SBRS were analyzed retrospectively. The majority of the patients had cervical cancer. Eleven patients had a history of prior radiotherapy either as postoperative adjuvant external beam radiotherapy (EBRT) with a median dose of 50.4 Gy (range 45-60 Gy) or definitive chemoradiotherapy as EBRT and high dose rate brachytherapy with a dose of 85-90 Gy low dose rate equivalent to point A. The prescribed dose of SBRS was 15-40 Gy (mean 26.6 Gy) in 3-5 fractions. Five patients with no prior radiotherapy received additional EBRT before SBRS. The median follow-up in all patients is 12 months (range 3-36 months). Six patients (37.5%) showed complete radiological and functional response to salvage SBRS. Six patients (37.5%) showed partial response and 2 (12.5%) showed stable disease. One and 2 year overall survival rates are 60.3% and 40.2% respectively. Progression free survival is 59%. All patients with complete response after SBRS are alive with no evidence of disease with a median follow up time of 20 months. SBRS is a promising treatment modality with high local control and reasonable complication rates in selected patients with recurrent gynecological cancer.Keywords: Cyberknife, Radiotherapy, Recurrent gynecological cancer, Salvage, Stereotactic radiosurgery ÖZET Rekürren Jinekolojik Kanser Tedavisinde Kurtarma Amaçl› Stereotaktik Vücut RadyocerrahisiLokal-bölgesel yineleme gözlenen jinekolojik kanserli hastalarda ölüm nedeni ço¤unlukla bölgesel hastal›kt›r. Seçilmifl grup hastada pelvik ekzenterasyon kür için tek seçenek olmufltur. Bu çal›flman›n amac› stereotaktik vücut radyocerrahisinin (SVRC) reküren jinekolojik kanserli hastalarda etkinli¤ini araflt›rmakt›r. SVRC ile tedavi edilen 16 hasta retrospektif olarak de¤erlendirilmifltir. Hastalar›n bü-yük ço¤unlu¤unun tan›s› serviks kanseridir. On bir hastan›n ilk tedavisinde postoperatif ya da küratif radyoterapi uygulanm›flt›r. SVRC ile reçete edilen doz 15-45 Gy' dir (ortalama 26.6 Gy) ve 3-5 fraksiyonda uygulanm›flt›r. Daha önce radyoterapi uygulanmayan hastalara eksternal tedavi SVRC öncesinde uygulanm›flt›r. Ortanca takip 12 ayd›r (3-36 ay). Alt› hastada (%37.5) radyolojik olarak tam cevap elde edilmifltir. Alt› hastada parsiyel cevap (%37.5) ve iki hastada stabil hastal›k (%12.5) gözlenmifltir. Bir ve 2 y›ll›k genel sa¤ kal›m oranlar› s›ras› ile % 60.3 ve % 40.2' dir. Progresyonsuz sa¤ kal›m % 59' dur. Tam cevap al›nan hastalar›n tamam› ortanca 20 ayl›k takipte hastal›ks›z hayattad›r. SVRC yüksek lokal kontrol oranlar› ve nispeten düflük komplikasyon yüzdesi ile reküren jinekolojik kanserli hastalarda seçilmifl bir grupta iyi bir tedavi seçene¤idir.

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Stoma Considerations Following Exenteration

Ramshorst

Tuynman

2021

Surgical Management of Advanced Pelvic Cancer

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Continent ileocolonic urinary reservoir (Miami pouch): the University of Miami experience over 15 years

Cited by 58 publications

References 28 publications

The Role of Exenterative Surgery and Urinary Diversion in Persistent or Locally Recurrent Gynecological Malignancy: Complications and Survival

The Role of Exenterative Surgery and Urinary Diversion in Persistent or Locally Recurrent Gynecological Malignancy: Complications and Survival

Salvage Stereotactic Body Radiosurgery in the Management of Recurrent Gynecological Cancer

Stoma Considerations Following Exenteration

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