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Combined Surgical Treatment for Advanced Pelvic Malignancy

  • N. D. Carr
  • M. G. Lucas

Abstract

Total pelvic exenteration or one of its modifications may seem a daunting prospect for both surgeon and patient alike. However, there is no doubt that a great deal can be achieved by the removal of these advanced primary or recurrent tumours and related structures in terms of achieving maximum palliation or even cure1–6. Although adjuvant treatment with radiotherapy, chemotherapy or both of these modalities may also be required, there is controversy about their value7 and the principle of surgical removal of all or most of the tumour bulk should be foremost in the clinician’s mind2,5.

Keywords

Pelvic Floor Urinary Diversion Myocutaneous Flap Pelvic Exenteration Ileal Conduit 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Avradopoulos KA, Vezeridis MP, Wanebo RJ (1996) Pelvic exenteration for recurrent rectal cancer. Adv Surg. 29:215–33PubMedGoogle Scholar
  2. 2.
    Bridges J, Oram D (1993) Management of advanced gynaecological malignancies. Br J Hosp Med 49:191–199PubMedGoogle Scholar
  3. 3.
    Franchi M, Donadello N (1994) Pelvic exenteration in gynecologic oncology. Eur J Gynecol Oncol 15:469–474Google Scholar
  4. Rogo KO, Stendahl U (1993) Management of recurrent cervical cancer: the place of ultraradical surgery. East Afr Med J 70:380–385Google Scholar
  5. 5.
    Rodriguez-Bigas MA, Petrelli NJ (1996) Pelvic exenteration and its modifications. Am J Surg 171:293–301CrossRefGoogle Scholar
  6. 6.
    Tarraza HM, Ellerkmann RM (1998) Pelvic radical surgery. Surg Oncol Clin North Am 7:399–416Google Scholar
  7. 7.
    Magrina JF (1993) Complications of irradiation and radical surgery for gynaecologic malignancies. Obstet Gynecol Surv 48:571–575PubMedCrossRefGoogle Scholar
  8. 8.
    Saunders N (1995) Pelvic exenteration: by whom and for whom? Lancet 345:5–6PubMedCrossRefGoogle Scholar
  9. 9.
    Brunschwig A (1948) Complete excision of pelvic viscera for advanced carcinoma. Cancer 1:177–183PubMedCrossRefGoogle Scholar
  10. 10.
    Brintnall ES, Flocks RH (1950) “En masse” Pelvic viscerectomy with ureterointestinal anastomosis. Arch Surg. 61:851–864CrossRefGoogle Scholar
  11. 11.
    Bricker EM, Modlin J (1951) The role of pelvic evisceration in surgery. Surgery 30:76–94PubMedGoogle Scholar
  12. 12.
    Brunschwig A (1956) Pelvic exenteration for carcinoma of the lower colon. Surgery 40:691–695PubMedGoogle Scholar
  13. 13.
    Kiselow M, Butcher HR, Bricker EM (1967) Results of the radical treatment of advanced pelvic cancer: a 15-year study. Ann Surg 166:428–436PubMedCentralPubMedGoogle Scholar
  14. 14.
    Rutledge FN, Smith JP, Wharton JT et al. (1977) Pelvic exenteration: analysis of 296 patients. Am J Obstet Gynecol 129:881–892PubMedGoogle Scholar
  15. 15.
    Shingleton HM, Soong SJ, Getter MS et al. (1989) Clinical and histopathological factors predicting recurrence and survival after pelvic exenteration for cancer of the cervix. Obstet Gynecol 73:1077–1034Google Scholar
  16. 16.
    Hafner GH, Herrera L, Petrelli NJ (1991) Patterns of recurrence after pelvic exenteration for colorectal carcinoma. Arch Surg 126:1510–1513PubMedCrossRefGoogle Scholar
  17. 17.
    Hida J, Yasutomi M, Maruyama T et al. (1998) Results from pelvic exenteration for locally advanced colorectal cancer with lymph node metastases. Dis Colon Rectum 41:165–168PubMedCrossRefGoogle Scholar
  18. 18.
    Lopez MJ, Standford SB, Skibba JI (1994) Total pelvic exenteration. Arch Surg 120:390–396CrossRefGoogle Scholar
  19. 19.
    Marshall FF, Treiger BF (1991) Radical cystectomy (anterior exenteration) in the female patient. Urol Clin North Am 18:765–775PubMedGoogle Scholar
  20. 20.
    Kevwitch MK, Walloch JL, Waters WB, Flanigan RC (1993) Prostatic cystic epithelial-stromal tumours: a report of 2 new cases. J Urol 149:860–864PubMedGoogle Scholar
  21. 21.
    Hicks BA, Hensle TW, Burbige KA, Altman RP (1993) Bladder management in children with genitourinary sarcoma. J Pediatr Surg 28:1019–1022PubMedCrossRefGoogle Scholar
  22. 22.
    Reid CG, Morley GW, Schmidt RW et al. (1989) The role of pelvic exenteration for sarcomatous malignancies. Obstet Gynecol 74:80–84PubMedGoogle Scholar
  23. 23.
    Takagi H, Morimoto T, Kato T et al. (1983) Pelvic exenteration combined with sacral resection for recurrent rectal cancer. J Surg Oncol 24:161–166PubMedCrossRefGoogle Scholar
  24. 24.
    Boey J, Wong J (1982) Pelvic exenteration for locally advanced colorectal carcinoma. Ann Surg 195:513–518PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Yeung RS, Moffat FL, Falk RE (1993) Pelvic exenteration for recurrent and extensive primary colorectal adenocarcinoma. Cancer 72:1853–1858PubMedCrossRefGoogle Scholar
  26. 26.
    Holmes SA, Christmas TJ, Kirby RS, Hendry WF (1992) Management of colovesical fistulae associated with pelvic malignncy. Br J Surg 79:432–434PubMedCrossRefGoogle Scholar
  27. 27.
    Hawighorst-Knapstein S, Shonefuss G, Hoffman SO, Knapstein PG (1997) Pelvic exenteration: effects of surgery on quality of life and body image - a prospective longitudinal study. Gynecol Oncol 66:495–500PubMedCrossRefGoogle Scholar
  28. 28.
    DiSaia P, Creaseman WT (1984) Invasive cervical cancer. In: DiSaia P, Creaseman WT (eds) Clinical gynaecologic oncology, 2nd edn. Mosby, St Louis, pp 61–125Google Scholar
  29. 29.
    Kraybill WG., Lopez MJ., Bricker EM (1988) Total pelvic exenteration as a therapeutic option in advanced malignant disease of the pelvis. Surg Obstet Gynecol 166:259–263Google Scholar
  30. 30.
    Lawhead RA Jr, Clark DG, Smith DH, Pierce VK, Lewis JL Jr (1989) Pelvic exenteration for recurrent or persistent gynecologic malignancies: a 10-year review of the Memorial Sloan-Kettering Cancer Center experience (1972–1981). Gynecol Oncol 33:279–282PubMedCrossRefGoogle Scholar
  31. 31.
    Robertson G, Lopes A, Beynon G, Monaghan JM (1994) Pelvic exenteration: a review of the Gateshead experience 1974–1992. Br J Obstet Gynecol 101:529–531CrossRefGoogle Scholar
  32. 32.
    Campbell SC, Church JM, Fazio VW, Klein EA, Pontes JE (1993) Combined radical retropubic prostatectomy and proctosigmoidectomy for en bloc removal of locally invasive carcinoma of the rectum. Surg Gynecol Obstet 176:605–608PubMedGoogle Scholar
  33. 33.
    Maetani S, Onodera T, Nishikawa T et al. (1998) Significance of local recurrence of rectal cancer as a local or disseminated disease. Br J Surg 85:521–525PubMedCrossRefGoogle Scholar
  34. 34.
    Goluboff ET, McKiernan JM, Todd G, Nowygrod R, Smith D, Olsson CA (1994) Reconstruction of urinary and gastrointestinal tracts in total pelvic exenteration: experience at Columbia Presbyterian Medical Center. Urology 44:666–670PubMedCrossRefGoogle Scholar
  35. 35.
    Skinner DG, Sherrod A (1990) Total pelvic exenteration with simultaneous bowel and urinary reconstruction. J Urol 144:1438–1439Google Scholar
  36. 36.
    Shepherd JH, Crawford RAF, Christmas TJ, Hendry WF (1997) Total pelvic reconstruction after exenteration for recurrent cervical cancer. Br J Urol 80 (Suppl 1):79–81PubMedGoogle Scholar
  37. 37.
    Skinner DG, Boyd SD, Lieskovsky G, Bennett C, Hopwood B (1991) Lower urinary tract reconstruction following cystectomy: experience and results in 126 patients using the Kock ileal reservoir with bilateral ureteroileal urethrostomy. J Urol 146:756–760PubMedGoogle Scholar
  38. 38.
    Berek JS, Hacker NF, Lagasse LD (1984) Rectosigmoid colectomy and reanastomosis to facilitate resection of primary and recurrent gynaecological cancer. Obstet Gynecol 64:715–720PubMedGoogle Scholar
  39. 39.
    Wheeless CR (1993) Low colorectal anastomosis and reconstruction after gynaecological cancer. Cancer 71:1664–1666PubMedCrossRefGoogle Scholar
  40. 40.
    Pare R, Tiret E, Frileux P, Moszkowki E, Loygue J (1986) Resection and coloanal anastomosis with colonic reservoir for rectal carcinoma. Br J Surg 73:139–141CrossRefGoogle Scholar
  41. 41.
    Williams NS (1989) Stapling technique for pouch anal anastomosis without the need for purse string suture. Br J Surg 76:348–349PubMedCrossRefGoogle Scholar
  42. 42.
    von Flue M, Harder F (1994) New technique for pouch-anal reconstruction after total mesorectal excision. Dis Colon Rectum 37:1160–1162CrossRefGoogle Scholar
  43. 43.
    Mundy AR (1993) Urodynamic and reconstructive surgery of the lower urinary tract. Churchill Livingstone. EdiburghGoogle Scholar
  44. 44.
    Woodhouse CRJ (1995) Continent urinary diversion: outlet considerations. Curr Opin Urol 5:123–126CrossRefGoogle Scholar
  45. 45.
    Bricker EM (1950) Bladder substitution after pelvic evisceration. Surg Clin North Am. 30:1511–1521PubMedGoogle Scholar
  46. 46.
    Sumfest JM, Burns MW, Mitchell ME (1993) The Mitrofanoff Principle in urinary reconstruction. J Urol 150:1875–1877PubMedGoogle Scholar
  47. 47.
    Barker SB (1991) Continent diversion with an appendix conduit and an ileocecal bladder. J Urol 146:745–754Google Scholar
  48. 48.
    Riedmiller H (1992) Appendix as continent urinary reservoir outlet. Scand J Urol Nephrol 142:73–75Google Scholar
  49. 49.
    Rowland RG (1996) Present experience with the Indiana Pouch. World J Urol 14:92–98PubMedCrossRefGoogle Scholar
  50. 50.
    Ghoneim MA (1992) The modified rectal bladder: a bladder substitute controlled by the anal sphincter. Scand J Urol Nephrol (Suppl) 142:89–91Google Scholar
  51. 51.
    Sundin T, Mansi MK (1993) The valved “S” shaped rectosigmoid pouch for continent urinary diversion. J Urol 150:838–842PubMedGoogle Scholar
  52. 52.
    Appleby LH (1950) Proctocystectomy. The management of colostomy with ureteral transplants. Am J Surg 79:57–60PubMedCrossRefGoogle Scholar
  53. 53.
    Osorio Gullon A, deOca J, Lopez Costea MA et al. (1997) Double-barrelled wet colostomy: a safe and simple method after pelvic exenteration. Int J Colorectal Dis 12:37–41PubMedCrossRefGoogle Scholar
  54. 54.
    Takada H et al. (1995) Double-barrelled wet colostomy. A simple method of urinary diversion for patients undergoing pelvic exenteration. Dis Colon Rectum 38:1325–1326PubMedCrossRefGoogle Scholar
  55. 55.
    Hendren WH, Atala A (1994) Use of bowel for vaginal reconstruction. J Urol 152:752–755PubMedGoogle Scholar
  56. 56.
    Benson C, Soisson AP, Carlson J, Culbertson G, Rawley-Bowland C, Richards F (1993) Neovaginal reconstruction with a rectus abdominis myocutaneous flap. Obstet Gynecol 81:871–875PubMedGoogle Scholar
  57. 57.
    Smith HO, Genesen MC, Runowicz CD, Goldberg GL (1998) The rectus abdominis myocutaneous flap: modifications, complications and sexual function. Cancer 83:510–520PubMedCrossRefGoogle Scholar
  58. 58.
    Loree TR, Hempling RE, Eltabakh GH et al. (1997) The inferior gluteal flap in the difficult vulvar and perineal reconstruction. Gynecol Oncol 66:429–433PubMedCrossRefGoogle Scholar
  59. 59.
    Clarke Pearson DL, Soper JT, Creasman WT (1988) Absorbable synthetic mesh (polyglactin) for the formation of a pelvic lid after radical pelvic resection. Am J Obstet Gynecol 158:158–161PubMedCrossRefGoogle Scholar
  60. 60.
    Jarrell MA, Malinin TI, Averette HE et al. (1987) Human Dura materallografts in repair of pelvic floor and abdominal wall defects. Obstet Gynecol 7:280–285Google Scholar
  61. 61.
    Brough WA, Schofield PF (1991) The value of rectus abdominis myocutaneous flap in the treatment of complex perineal fistula. Dis Colon Rectum 34:148–150PubMedCrossRefGoogle Scholar
  62. 62.
    Keighley MRB (1993) Pesistent perineal sinus. In: Keighley MBR, Williams NS (eds) Surgery of the anus, rectum and colon. Saunders, London, pp 260–264Google Scholar
  63. 63.
    Symmonds RE, Pratt JH, Webb MJ (1975) Exenterative operations: experience with 198 patients. Am J Obstet Gynecol 121:907–918PubMedGoogle Scholar
  64. 64.
    Jakowatz JG, Porudominski D, Riihimaki DU et al. (1985) Complications of pelvic exenteration. Arch Surg 120:1261–1265PubMedCrossRefGoogle Scholar
  65. 65.
    Lindsey WF, Wood DK, Briele HA (1985) Pelvic exenteration. J Surg Oncol 30:231–234PubMedCrossRefGoogle Scholar
  66. 66.
    Morely GW, Hopkins MP, Lindenauer SM, Roberts JA (1989) Pelvic exenteration, University of Michigan: 100 patients at 5 years. Obstet Gynecol 74:934–943Google Scholar
  67. 67.
    Soper JT, Berchuk A, Creasman WT (1989) Pelvic exenteration: factors associated with major surgical morbidity. Gynecol Oncol 35:93–98PubMedCrossRefGoogle Scholar
  68. 68.
    Wanebo HJ, Koness RJ, Vezeridis MP, Cohen SI, Wrobleski DE (1994) Pelvic resection of recurrent rectal cancer. Ann Surg 220:586–597PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2000

Authors and Affiliations

  • N. D. Carr
  • M. G. Lucas

There are no affiliations available

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