Abstract
Objective
To report morbidity and oncological outcomes in a consecutive series of lateral isolated
recurrent gynecological cancer involving the pelvic side wall (PSW) including the
iliopsoas muscle.
Material and methods
We retrospectively evaluated a consecutive series between 6/2013 and 12/2015 of lateral
isolated recurrent gynecological malignancies treated with a lateral endopelvic resection
(LEPR). LEPR was defined as an en-bloc lateral resection of a pelvic tumor with sidewall muscle, and/or bone, and/or major nerve,
and/or major vascular structure. Post-surgical complications, quality of life (QoL)
and survivals were computed.
Results
Seventy-four women with pelvic isolated relapse were admitted for surgery during the
study period. Among them, 8 cases (10.8%) showed lateral isolated relapse involving
the iliopsoas muscle and were treated with LEPR. R0 resection was achieved in 6/8
patients (75.0%), while the pathologic margins were microscopically and macroscopically
positive in 1 patient (12.5%), respectively. There were no perioperative mortalities.
Major postoperative complications occurred in 3 patients (37.5%) through peripheral
neuropathies, thrombosis of the vascular graft and compartment syndrome of the leg.
Median follow-up time was 21 months (range, 12–28). The 2-year overall survival (OS)
was 88% improving up to 100% if R0 resection was achieved. In patients with positive
pathologic margins (n = 2), the 2-year OS was 50%. All women showed an improved QoL
after surgery.
Conclusion
LEPR with iliopsoas resection can be safely performed in selected cases with lateral
isolated gynecological relapse involving the PSW and was associated with improved
QoL and prolonged survival when an R0 resection was achieved.
Keywords
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References
- Complete excision of pelvic viscera for advanced carcinoma; a one-stage abdominoperineal operation with end colostomy and bilateral ureteral implantation into the colon above the colostomy.Cancer. 1948; 1: 177-183
- Relative prognostic significance of preoperative and operative findings in pelvic exenteration.Surg Clin N Am. 1968; 2: 431-447
- Morbidity after pelvic exenteration for gynecological malignancies: a retrospective multicentric study of 230 patients.Int J Gynecol Cancer. 2014 Jan; 24: 156-164
- Curative pelvic exenteration for recurrent cervical carcinoma in the era of concurrent chemotherapy and radiation therapy. A systematic review.Eur J Surg Oncol. 2015 Aug; 41: 975-985
- Exenterative surgery for recurrent gynaecological malignancies.Cochrane Database Syst Rev. 2014 Feb 4; : CD010449
- Long-term experience with (laterally) extended endopelvic resection (LEER) in relapsed pelvic malignancies.Curr Oncol Rep. 2015 Mar; 17: 435
- Role of MR imaging and FDG PET/CT in selection and follow-up of patients treated with pelvic exenteration for gynecologic malignancies.Radiographics. 2015 Jul-Aug; 35: 1295-1313
- Extended pelvic resections for recurrent uterine and cervical cancer: out-of-the-box surgery.Int J Gynecol Cancer. 2008; 18: 1139-1144
- Extended pelvic resections for recurrent or persistent uterine and cervical malignancies: an update on out of the box surgery.Gynecol Oncol. 2012 May; 125: 404-408
- Radical pelvic resection and intraoperative radiation therapy for recurrent endometrial cancer: technique and analysis of outcomes.Gynecol Oncol. 2006; 101: 280-286
- Total pelvic exenteration: the Albert Einstein College of Medicine/Montefiore Medical Center Experience (1987 to 2003).Gynecol Oncol. 2006; 101: 261-268
- External hemipelvectomy as treatment for solitary coxofemoral metastasis from endometrial carcinoma: case report and review of the literature.J Obstet Gynaecol Res. 2012 May; 38: 892-898
- Lateral pelvic compartment excision during pelvic exenteration.Br J Surg. 2015 Dec; 102: 1710-1717
- Comparison of ECOG/WHO performance status and ASA score as a measure of functional status.J Pain Symptom Manage. 2015 Feb; 49: 258-264
- Development and assessment of Memorial Sloan Kettering Cancer Center's Surgical Secondary Events grading system.Ann Surg Oncol. 2015 Apr; 22: 1061-1067
- Functional evaluation: the Barthel Index.Md State Med J. 1965; 14: 61-65
- Validation of single-item Linear Analog Scale Assessment of quality of life in neuro-oncology patients.J Pain Symptom Manage. 2007; 34: 628-638
- Does intra-operative radiation at the time of pelvic exenteration improve survival for patients with recurrent, previously irradiated cervical, vaginal, or vulvar cancer?.Gynecol Oncol. 2014; 135: 95-99
- Concurrent 5-fluorouracil, mitomycin C and radiation with or without brachytherapy in recurrent cervical cancer: a scoring system to predict clinical response and outcome.Tumori. 2005 Jul-Aug; 91: 295-301
- Concurrent 5-fluorouracil, mitomycin C and radiation, with or without brachytherapy, in recurrent endometrial cancer: a scoring system to predict clinical response and outcome.Tumori. 2005 May–Jun; 91: 215-220
Article info
Publication history
Published online: November 17, 2016
Accepted:
October 31,
2016
Identification
Copyright
© 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
