Pelvic exenteration: Pre-, intra-, and post-operative considerations

Ng, Kheng‐Seong; Lee, Peter J. M.

doi:10.1016/j.suronc.2021.101546

Cited by 12 publications

(3 citation statements)

References 72 publications

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“…It is, therefore, of paramount importance to carefully select patients for surgery. MRI has emerged as the gold standard for assessment of the tumor spread in the small pelvis [8][9][10]. However, beyond-TME surgery is rather a surgical strategy than a clearly defined procedure.…”

Section: Introductionmentioning

confidence: 99%

Beyond Total Mesorectal Excision (TME)—Results of MRI-Guided Multivisceral Resections in T4 Rectal Carcinoma and Local Recurrence

Stelzner,

Kittner,

Schneider

et al. 2023

Cancers

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Rectal cancer invading adjacent organs (T4) and locally recurrent rectal cancer (LRRC) pose a special challenge for surgical resection. We investigate the diagnostic performance of MRI and the results that can be achieved with MRI-guided surgery. All consecutive patients who underwent MRI-based multivisceral resection for T4 rectal adenocarcinoma or LRRC between 2005 and 2019 were included. Pelvic MRI findings were reviewed according to a seven-compartment staging system and correlated with histopathology. Outcomes were investigated by comparing T4 tumors and LRRC with respect to cause-specific survival in uni- and multivariate analysis. We identified 48 patients with T4 tumors and 28 patients with LRRC. Overall, 529 compartments were assessed with an accuracy of 81.7%, a sensitivity of 88.6%, and a specificity of 79.2%. Understaging was as low as 3.0%, whereas overstaging was 15.3%. The median number of resected compartments was 3 (interquartile range 3–4) for T4 tumors and 4 (interquartile range 3–5) for LRRC (p = 0.017). In 93.8% of patients with T4 tumors, a histopathologically complete (R0(local)-) resection could be achieved compared to 57.1% in LRRC (p < 0.001). Five-year overall survival for patients with T4 tumors was 53.3% vs. 32.1% for LRRC (p = 0.085). R0-resection and M0-category emerged as independent prognostic factors, whereas the number of resected compartments was not associated with prognosis in multivariate analysis. MRI predicts compartment involvement with high accuracy and especially avoids understaging. Surgery based on MRI yields excellent loco-regional results for T4 tumors and good results for LRRC. The number of resected compartments is not independently associated with prognosis, but R0-resection remains the crucial surgical factor.

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Section: Introductionmentioning

confidence: 99%

Beyond Total Mesorectal Excision (TME)—Results of MRI-Guided Multivisceral Resections in T4 Rectal Carcinoma and Local Recurrence

Stelzner,

Kittner,

Schneider

et al. 2023

Cancers

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“…Resection of pelvic tissues that receive radiotherapy may lead to various fistulas, poor wound prognosis, and secondary problems caused by ureteral or intestinal obstruction. However, type III exenteration could reduce the incidence of complications [ 7 ], such as intestinal obstruction, pelvic abscess, and fistula formation [ 8 – 10 ], in patients who need pelvic floor reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Application of depithelized gracilis adipofascial flap for pelvic floor reconstruction after pelvic exenteration

Zhang

Yang

2022

BMC Surg

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Background Pelvic exenteration is a radical surgery performed in selected patients with locally advanced or recurrent pelvic malignancy. It involves radical en bloc resection of the adjacent anatomical structures affected by the tumor. The authors sought to evaluate the clinical application of a depithelized gracilis adipofascial flap for pelvic floor reconstruction after pelvic exenteration. Methods A total of 31 patients who underwent pelvic floor reconstruction with a gracilis adipofascial flap after pelvic exenterationat Peking University Third Hospital from 2014 to 2022 were enrolled in the study. The postoperative follow-up durations varied from 4 to 12 months. Results The survival rate of the flap was 96.77% with partial flap necrosis in one case. The total incidence of postoperative complications associated with the flap was 25.81%, with an incidence of 6.45% in the donor site and 19.35% in the recipient site. All complications were early complications, including postoperative infection and flap necrosis. All patients recovered after treatments, including anti-infectives, dressing change, debridement, and local flap repair. Long-term follow-up showed good outcomes without flap-related complications. Conclusions A depithelized gracilis adipofascial flap can be applied for pelvic floor reconstruction after pelvic exenteration. The flap is an ideal and reliable choice for pelvic floor reconstruction with few complications, an elevated survival rate, sufficient volume, and mild effects on the function of the donor site.

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Locally advanced or recurrent rectal cancer invades surrounding tissues and organs, and R0 resection is the key to a better prognosis.However, tissue loss from anatomical resection of involved pelvic organs often leads to postoperative complications. Common complications, such as pelvic abscess and fistula, intestinal obstruction and poor perineal wound healing, are collectively referred to as 'empty pelvis syndrome' [1]. Vascularized tissue is used to eliminate the dead space in the pelvis, close the perineal wound and reconstruct the extensive defects within the pelvic floor, perineum, vulva and gluteal regions [2].

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mentioning

confidence: 99%

Perineal defect reconstruction after surgery for advanced or locally recurrent rectal cancer involving organ resection: Multiple flaps combined with lining repair

Gao,

Wang,

Zeng

et al. 2023

Colorectal Disease

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AimThe aim of this study was to investigate the efficacy of multiple perineal perforator flaps in repairing deep perineal defects after pelvic exenteration for locally advanced or recurrent rectal cancer.MethodWe investigated the outcomes of eight patients whose repairs involved a novel method of using an internal pudendal artery perforator (IPAP) flap combined with an inferior gluteal artery perforator (IGAP) flap.ResultsThere were four male and four female patients with a mean age of 56 years (36–72 years). Bilateral IPAP flaps combined with bilateral IGAP flaps were used in five patients, unilateral IPAP flaps combined with bilateral IGAP flaps were used in two patients and bilateral IPAP flaps were used in one patient. There were no functional limitations in daily activities during the 6‐month follow‐up period.ConclusionOur study showed that using multiple perineal perforator flaps combined with lining repair is feasible for repairing deep perineal defects in patients who have undergone rectal cancer surgery that includes pelvic exenteration.

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Pelvic exenteration: Pre-, intra-, and post-operative considerations

Cited by 12 publications

References 72 publications

Beyond Total Mesorectal Excision (TME)—Results of MRI-Guided Multivisceral Resections in T4 Rectal Carcinoma and Local Recurrence

Beyond Total Mesorectal Excision (TME)—Results of MRI-Guided Multivisceral Resections in T4 Rectal Carcinoma and Local Recurrence

Application of depithelized gracilis adipofascial flap for pelvic floor reconstruction after pelvic exenteration

Perineal defect reconstruction after surgery for advanced or locally recurrent rectal cancer involving organ resection: Multiple flaps combined with lining repair

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