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De Crignis L, Dupré A, Meeus P, Peyrat P, Rivoire M. Surgical outcomes in pelvic exenteration for advanced and recurrent malignancy: a high volume single institution experience. Langenbecks Arch Surg 2023; 408:221. [PMID: 37261533 DOI: 10.1007/s00423-023-02960-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE Pelvic exenteration remains the only curative treatment for advanced pelvic malignancies. However, identification of predictive factors for successful surgical outcomes is still a controversial issue at present time. METHODS This retrospective study included data from all adult patients with colorectal or anal advanced pelvic malignancy registered for pelvic exenteration at the Leon Berard Cancer Center (Lyon, France). The primary endpoint was the surgical outcomes and aimed to define the predictive factors for postoperative complications. Secondary endpoints included overall survival and progression free survival in patients having experienced pelvic exenteration (PE). RESULTS Data from 141 patients with locally advanced tumor (N = 81) or recurrent malignancies (N = 60) diagnosed between May 1994 and November 2018 were collected. The median age was 63.3 years (95%CI 20.0-92.0). Malignancies included different locations (rectal: 69.5%, left colon: 17.0% and anal: 13.5%). Posterior pelvectomy was the most frequent surgery (81.6%). The median length of hospital stay was 23.3 days (95%CI 3.0-82.0). The major complication rate at 30 days was 24.8% and 38.1% at 90 days. The median overall survival was 54.5 months (95%CI 41.5-104.1) and the median PFS was 34.5 months (95%CI 19.6-NA). CONCLUSION In selected patients, pelvic exenteration is associated with good surgical and survival outcomes.
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Affiliation(s)
- Lucas De Crignis
- Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France.
| | - Aurélien Dupré
- Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France
- Univ Lyon, Inserm, U1032 LabTau, 69003, Lyon, France
| | - Pierre Meeus
- Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France
| | - Patrice Peyrat
- Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France
| | - Michel Rivoire
- Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France
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2
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Irani JL, Hedrick TL, Miller TE, Lee L, Steinhagen E, Shogan BD, Goldberg JE, Feingold DL, Lightner AL, Paquette IM. Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. Surg Endosc 2023; 37:5-30. [PMID: 36515747 PMCID: PMC9839829 DOI: 10.1007/s00464-022-09758-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 12/15/2022]
Abstract
The American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) are dedicated to ensuring high-quality innovative patient care for surgical patients by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus as well as minimally invasive surgery. The ASCRS and SAGES society members involved in the creation of these guidelines were chosen because they have demonstrated expertise in the specialty of colon and rectal surgery and enhanced recovery. This consensus document was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus and develop clinical practice guidelines based on the best available evidence. While not proscriptive, these guidelines provide information on which decisions can be made and do not dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, healthcare workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. These guidelines should not be deemed inclusive of all proper methods of care nor exclusive of methods of care reasonably directed toward obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient. This clinical practice guideline represents a collaborative effort between the American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and was approved by both societies.
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Affiliation(s)
- Jennifer L Irani
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Traci L Hedrick
- Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Timothy E Miller
- Duke University Medical Center Library, Duke University School of Medicine, Durham, NC, USA
| | - Lawrence Lee
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Emily Steinhagen
- Department of Surgery, University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Benjamin D Shogan
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Joel E Goldberg
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel L Feingold
- Section of Colorectal Surgery, Rutgers University, New Brunswick, NJ, USA
| | - Amy L Lightner
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, USA
| | - Ian M Paquette
- Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine Surgery (Colon and Rectal), 222 Piedmont #7000, Cincinnati, OH, 45219, USA.
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3
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Irani JL, Hedrick TL, Miller TE, Lee L, Steinhagen E, Shogan BD, Goldberg JE, Feingold DL, Lightner AL, Paquette IM. Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 2023; 66:15-40. [PMID: 36515513 PMCID: PMC9746347 DOI: 10.1097/dcr.0000000000002650] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jennifer L. Irani
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Traci L. Hedrick
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Timothy E. Miller
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Lawrence Lee
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Emily Steinhagen
- Department of Surgery, University Hospital Cleveland Medical Center, Cleveland, Ohio
| | - Benjamin D. Shogan
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Joel E. Goldberg
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel L. Feingold
- Department of Surgery, Section of Colorectal Surgery, Rutgers University, New Brunswick, New Jersey
| | - Amy L. Lightner
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland Clinic
| | - Ian M. Paquette
- Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
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4
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Persson P, Chong P, Steele C, Quinn M. Prevention and management of complications in pelvic exenteration. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:2277-2283. [DOI: 10.1016/j.ejso.2021.12.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022]
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Bislenghi G, Vanhaverbeke A, Fieuws S, de Buck van Overstraeten A, D’Hoore A, Schuermans A, Wolthuis AM. Risk factors for surgical site infection after colorectal resection: a prospective single centre study. An analysis on 287 consecutive elective and urgent procedures within an institutional quality improvement project. Acta Chir Belg 2021; 121:86-93. [PMID: 31577178 DOI: 10.1080/00015458.2019.1675969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM To determine the incidence and to investigate risk factors for surgical site infections (SSIs) in a cohort of patients undergoing colorectal surgery. MATERIAL & METHODS Data from all consecutive patients operated at our department in an elective or in an urgent setting over a 4-month period were prospectively collected and analysed. The updated Centres for Disease Control and Prevention guidelines were used to define and to score SSIs during weekly meetings. Multivariate analysis was performed considering a list of 20 potential perioperative risk factors. RESULTS A total of 287 patients (mean age 56.9 ± 16.8 years, 51.2% male) were included. Thirty-five patients (12.2%) developed SSI. Independent risk factors for SSI were BMI <20 kg/m2 (OR 3.70; p = .022), cancer (OR 0.33; p = .046), respiratory comorbidity (OR 3.15; p = .035), presence of a preoperative stoma (OR 3.74; p = .003), and operative time ≥3 hours (OR 2.93; p = .014). CONCLUSION Identified incidence and risk factors for the development of SSI after colorectal surgery were consistent with those already reported in the literature. The possibility to develop a validated prediction model for SSIs warrants further investigation, in order to target specific preventive measures on high-risk population.
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Affiliation(s)
- Gabriele Bislenghi
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Steffen Fieuws
- Interuniversity Center for Biostatistics and Statistical Bioinformatics, KU Leuven, University of Leuven and University of Hasselt, Leuven, Belgium
| | | | - André D’Hoore
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Annette Schuermans
- Department of Public Health and Primary Care, University Hospitals Leuven, Leuven, Belgium
| | - Albert M. Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
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Sawan D, Bosc R, La Padula S, Leblanc E, Narducci F, Touboul C, Meningaud JP, Hersant B. Immediate vaginal reconstruction following pelvic exenteration using the pedicled vertical Deep Inferior Epigastric Perforator (DIEP) flap: A technical note. ANN CHIR PLAST ESTH 2020; 65:e1-e5. [PMID: 32536474 DOI: 10.1016/j.anplas.2019.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/11/2019] [Accepted: 09/26/2019] [Indexed: 10/24/2022]
Abstract
Immediate vaginal reconstruction is usually offered following pelvic exenteration for recurrent cervical cancer in women previously treated with radiotherapy or with severe radiation-induced fistulae. Introduction of muscle-sparing flaps, such as the pedicled vertical deep inferior epigastric perforator (DIEP) flap, provides viable tissues for vaginal reconstruction and is associated with reduced donor-site morbidity. This report describes the surgical technique, which is one of the procedures of choice for vaginal reconstruction. It is safe and beneficial, especially for women with gynecologic cancer who have undergone pelvic exenteration after failed radiation therapy.
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Affiliation(s)
- D Sawan
- Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri-Mondor University Hospital, 94000 Créteil, France.
| | - R Bosc
- Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri-Mondor University Hospital, 94000 Créteil, France
| | - S La Padula
- Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri-Mondor University Hospital, 94000 Créteil, France
| | - E Leblanc
- Department of Surgical Oncology, Oscar Lambret, 59000 Lille, France
| | - F Narducci
- Department of Surgical Oncology, Oscar Lambret, 59000 Lille, France
| | - C Touboul
- Intercommunal Hospital Center of Creteil, 94000 Créteil, France
| | - J-P Meningaud
- Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri-Mondor University Hospital, 94000 Créteil, France
| | - B Hersant
- Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri-Mondor University Hospital, 94000 Créteil, France
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Carboni F, Federici O, Giofre' M, Zazza S, Valle M. Empty pelvis syndrome: the use of breast prosthesis in the prevention of complications. Colorectal Dis 2019; 21:1321-1325. [PMID: 31230404 DOI: 10.1111/codi.14737] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 06/03/2019] [Indexed: 12/16/2022]
Abstract
AIM Empty pelvis syndrome and radiation-induced bowel injury are two major clinical issues resulting from the pelvic dead space after pelvic exenteration (PE). In order to avoid these complications, different methods of pelvic floor reconstruction have been proposed. We report our experience on the use of breast prosthesis. METHOD Fifty-three patients who underwent PE and three who underwent palliative surgery with silicone breast prosthesis placement were included. RESULTS Forty-seven posterior PE, six total PE and three palliative procedures were identified. Sphincter preservation was feasible in 34 patients (62.3%). There were no deaths. Overall morbidity was 37.5%. There were no complications such as sepsis or obstruction related to the prosthesis. Adjuvant radiotherapy was delivered in 16 cases (30.1%) without any side-effects. Reconstruction of intestinal continuity was possible in 12 patients (36.3%) with sphincter preservation and the prosthesis allowed a prompt identification of the rectal stump. CONCLUSION Breast prosthesis placement is a simple and safe method to minimize complications resulting from empty pelvis syndrome and can be adopted to exclude bowel loops from the radiation field. Reconstruction of intestinal continuity after resection is also simplified.
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Affiliation(s)
- F Carboni
- Department of Digestive Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - O Federici
- Department of Digestive Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - M Giofre'
- Department of Digestive Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - S Zazza
- Department of Digestive Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - M Valle
- Department of Digestive Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Baird DLH, Simillis C, Pellino G, Kontovounisios C, Rasheed S, Tekkis PP. The obesity paradox in beyond total mesorectal excision surgery for locally advanced and recurrent rectal cancer. Updates Surg 2019; 71:313-321. [PMID: 30790208 PMCID: PMC6647851 DOI: 10.1007/s13304-019-00631-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/11/2019] [Indexed: 12/18/2022]
Abstract
The objective is to investigate preoperative body mass index (BMI) in patients receiving beyond total mesorectal excision (bTME) surgery. The primary end point is length of postoperative stay. Secondary end points are length of intensive care stay, postoperative morbidity and overall survival. BMI is the most commonly used anthropometric measurement of nutrition and studies have shown that overweight and obese patients can have improved surgical outcomes. Patients who underwent a bTME operation for locally advanced or recurrent rectal cancer were put into three BMI (kg/m2) groups of normal weight (18.5-24.9), overweight (25-29.9) and obese (≥ 30) for analysis. Included are 220 consecutive patients from a single centre. The overall length of stay, in days ± standard deviation (range), for normal weight, overweight and obese patients was 21.14 ± 16.4 (6-99), 15.24 ± 4.3 (7-32) and 19.10 ± 9.8 (8-62) respectively (p = 0.002). The mean ICU length of stay was 5.40 ± 9.1 (1-69), 3.37 ± 2.4 (0-19) and 3.60 ± 2.4 (1-14), respectively (p = 0.030). There was no significant difference between the three groups in terms of postoperative morbidity or overall survival. Patients with a normal weight BMI in this cohort have a significantly longer length of stay in ICU and in hospital than overweight or obese patients. This is seen with no significant difference in morbidity or overall survival.
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Affiliation(s)
- Daniel L H Baird
- Department of Colorectal Surgery, The Royal Marsden Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK
| | | | - Gianluca Pellino
- Department of Colorectal Surgery, The Royal Marsden Hospital, London, UK
| | - Christos Kontovounisios
- Department of Colorectal Surgery, The Royal Marsden Hospital, London, UK.
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK.
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK.
| | - Shahnawaz Rasheed
- Department of Colorectal Surgery, The Royal Marsden Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
| | - Paris P Tekkis
- Department of Colorectal Surgery, The Royal Marsden Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
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Guo Y, Chang E, Bozkurt M, Park M, Liu D, Fu JB. Factors affecting hospital length of stay following pelvic exenteration surgery. J Surg Oncol 2017; 117:529-534. [PMID: 29044540 DOI: 10.1002/jso.24878] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 09/19/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Total pelvic exenteration are performed in patients with locally advanced or recurrent pelvic malignances. Many patients have prolong hospital length of stay (LOS), but risk factors are not clearly identified. METHODS From 2002 through 2012, 100 consecutive patients undergoing pelvic exenteration were retrospectively reviewed. A general linear model was used to examine risk factors for prolonged hospital LOS. RESULTS Among the 100 patients, 51 had gastrointestinal cancer, 14 had genitourinary cancer, 31 had gynecologic cancer, and 4 had sarcoma. Perioperative complications included infection (n = 44), anastomotic leak/fistula (n = 6), wound or flap dehiscence (n = 11), and ileus or bowel obstruction (n = 30). The median (Interquartile range (IQR)) hospital LOS was 15 days (10-21.5 days). On multivariate regression analysis, hospital LOS was significantly prolonged by underweight status, genitourinary cancer or sarcoma diagnosis, ≥2 infections, anastomotic leak/fistula, requiring rehabilitation consult and admission, and ≥2 consultations (P = 0.05). CONCLUSION In patients undergoing pelvic exenteration, prolonged hospital LOS is associated with underweight status, genitourinary cancer or sarcoma diagnosis, more than one infection, anastomotic leak/fistula, requiring rehabilitation consult and admission, and more than one consultation. Further study is needed to assess whether minimizing these risk factors can improve hospital LOS in these patients.
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Affiliation(s)
- Ying Guo
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eugene Chang
- Department of Medicine, Division of Physical Medicine and Rehabilitation, Toronto Rehabilitation Institute, Toronto, Canada
| | - Mehtap Bozkurt
- Department of Physical Medicine and Rehabilitation, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Minjeong Park
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diane Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack B Fu
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L, Boutros M, McClane J, Steele SR, Feldman LS. Clinical practice guideline for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons (ASCRS) and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Surg Endosc 2017; 31:3412-3436. [DOI: 10.1007/s00464-017-5722-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/10/2017] [Indexed: 12/16/2022]
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Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 2017; 60:761-784. [PMID: 28682962 DOI: 10.1097/dcr.0000000000000883] [Citation(s) in RCA: 266] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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12
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Minar L, Felsinger M, Rovny I, Zlamal F, Bienertova-Vasku J, Jandakova E. Modified posterior pelvic exenteration for advanced ovarian malignancies: a single-institution study of 35 cases. Acta Obstet Gynecol Scand 2017; 96:1136-1143. [PMID: 28585317 DOI: 10.1111/aogs.13177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/31/2017] [Indexed: 12/28/2022]
Abstract
INTRODUCTION This study aimed to investigate the possible benefits of a complete cytoreduction in patients with advanced ovarian cancer and concomitant rectal invasion. Furthermore, we evaluated the morbidity associated with radical surgery. MATERIAL AND METHODS A retrospective analysis examined 35 women who underwent radical surgery in the form of modified posterior pelvic exenteration. Descriptive statistics, Kaplan-Meier survival curves and log-rank test were used for statistical estimations. Surgical complications were analyzed using the Clavien-Dindo classification. RESULTS The analysis of survival in relation to residual disease assessed according to Sugarbaker confirmed an optimistic prognosis in patients with optimal debulking with a mean disease-free survival period of 33.6 months in R0 patients, 19.6 months in R1 patients, and 14.3 months in R2 patients. A statistically significant difference in disease-free survival (p = 0.023) was observed between the R0 (without residual disease) and R1+2 (with residual disease) groups. Surgical complications occurred in 83% of patients, with early postoperative complications being most frequent (65.7%). While grade III-IV complications occurred in 37.7% of all patients, no cases of surgery-associated mortality occurred. CONCLUSIONS Modified posterior pelvic exenteration is a highly effective method for achieving optimal debulking in cases of advanced ovarian cancer with the direct invasion of the rectum. Modified posterior pelvic exenteration does not delay the beginning of complementary chemotherapy. However, it is necessary to take into account surgery-related morbidity. As modified posterior pelvic exenteration represents an extremely invasive technique, the surgical plan and perioperative care should be personalized to address the individual medical and surgical conditions of each patient.
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Affiliation(s)
- Lubos Minar
- Department of Obstetrics and Gynecology, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michal Felsinger
- Department of Obstetrics and Gynecology, University Hospital Brno, Brno, Czech Republic
| | - Ivo Rovny
- Department of Surgery, University Hospital Brno, Brno, Czech Republic
| | - Filip Zlamal
- Research Center for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Brno, Czech Republic.,Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Julie Bienertova-Vasku
- Research Center for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Brno, Czech Republic.,Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Eva Jandakova
- Department of Pathology, University Hospital Brno, Brno, Czech Republic
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13
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Bloemendaal ALA, Kraus R, Buchs NC, Hamdy FC, Hompes R, Cogswell L, Guy RJ. Double-barrelled wet colostomy formation after pelvic exenteration for locally advanced or recurrent rectal cancer. Colorectal Dis 2016; 18:O427-O431. [PMID: 27620339 DOI: 10.1111/codi.13512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/11/2016] [Indexed: 12/11/2022]
Abstract
AIM In advanced pelvic cancer it may be necessary to perform a total pelvic exenteration. In such cases urinary tract reconstruction is usually achieved with the creation of an ileal conduit with a urinary stoma on the right side of the patient's abdomen and an end colostomy separately on the left. The potential morbidity from a second stoma may be avoided by the use of a double-barrelled wet colostomy (DBWC), as a single stoma. Another advantage is the possibility of using a vertical rectus abdominis muscle flap for perineal reconstruction. METHOD All patients undergoing formation of a DBWC were included. RESULT A DBWC was formed in 10 patients. One patient underwent formation of a double-barrelled wet ileostomy. CONCLUSIONS In this technical note we present our early experience in 11 cases and a video of DBWC formation in a male patient.
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Affiliation(s)
- A L A Bloemendaal
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - R Kraus
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - N C Buchs
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - F C Hamdy
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - R Hompes
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - L Cogswell
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R J Guy
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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