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Cianci S, Arcieri M, Vizzielli G, Martinelli C, Granese R, La Verde M, Fagotti A, Fanfani F, Scambia G, Ercoli A. Robotic Pelvic Exenteration for Gynecologic Malignancies, Anatomic Landmarks, and Surgical Steps: A Systematic Review. Front Surg 2021; 8:790152. [PMID: 34917648 PMCID: PMC8669266 DOI: 10.3389/fsurg.2021.790152] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Pelvic exenteration represents the last resort procedure for patients with advanced primary or recurrent gynecological malignancy. Pelvic exenteration can be divided into different subgroup based on anatomical extension of the procedures. The growing application of the minimally invasive surgical approach unlocked new perspectives for gynecologic oncology surgery. Minimally invasive surgery may offer significant advantages in terms of perioperative outcomes. Since 2009, several Robotic Assisted Laparoscopic Pelvic Exenteration experiences have been described in literature. The advent of robotic surgery resulted in a new spur to the worldwide spread of minimally invasive pelvic exenteration. We present a review of the literature on robotic-assisted pelvic exenteration. The search was conducted using electronic databases from inception of each database through June 2021. 13 articles including 53 patients were included in this review. Anterior exenteration was pursued in 42 patients (79.2%), 2 patients underwent posterior exenteration (3.8%), while 9 patients (17%) were subjected to total exenteration. The most common urinary reconstruction was non-continent urinary diversion (90.2%). Among the 11 women who underwent to total or posterior exenteration, 8 (72.7%) received a terminal colostomy. Conversion to laparotomy was required in two cases due to intraoperative vascular injury. Complications' report was available for 51 patients. Fifteen Dindo Grade 2 complications occurred in 11 patients (21.6%), and 14 grade 3 complications were registered in 13 patients (25.5%). Only grade 4 complications were reported (2%). In 88% of women, the resection margins were negative. Pelvic exenteration represents a salvage procedure in patients with recurrent or persistent gynecological cancers often after radiotherapy. A careful patient selection remains the milestone of such a mutilating surgery. The introduction of the minimally invasive approach has led to advantages in terms of perioperative outcomes compared to classic open surgery. This review shows the feasibility of robotic pelvic exenteration. An important step forward should be to investigate the potential equivalence between robotic approaches and the laparotomic one, in terms of long-term oncological outcomes.
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Affiliation(s)
- Stefano Cianci
- Department of Human Pathology of Adult and Childhood "G. Barresi", Unit of Gynecology and Obstetrics, University of Messina, Messina, Italy
- *Correspondence: Stefano Cianci
| | - Martina Arcieri
- Department of Biomedical, Dental, Morphological, and Functional Imaging Sciences, University of Messina, Messina, Italy
| | - Giuseppe Vizzielli
- Department of Obstetrics Gynecology and Pediatrics, University of Udine, Udine, Italy
| | - Canio Martinelli
- Department of Human Pathology of Adult and Childhood "G. Barresi", Unit of Gynecology and Obstetrics, University of Messina, Messina, Italy
| | - Roberta Granese
- Department of Biomedical, Dental, Morphological, and Functional Imaging Sciences, University of Messina, Messina, Italy
| | - Marco La Verde
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Fanfani
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Alfredo Ercoli
- Department of Human Pathology of Adult and Childhood "G. Barresi", Unit of Gynecology and Obstetrics, University of Messina, Messina, Italy
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Cunneen C, Kelly M, Nason G, Ryan E, Creavin B, Winter D. The Role of Exenterative Surgery in Advanced Urological Neoplasms. Curr Urol 2020; 14:57-65. [PMID: 32774229 DOI: 10.1159/000499258] [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] [Received: 01/26/2019] [Accepted: 02/11/2019] [Indexed: 01/22/2023] Open
Abstract
Pelvic exenterative surgery is both complex and challenging, especially in the setting of locally recurrent disease. In recent decades, improved surgical techniques have facilitated more extensive resection of both locally advanced and recurrent pelvic malignancies, but its role in urological cancer surgery is highly selective. However, it remains an important part of the armamentarium for the management of bladder and prostate cancer cases where there is local invasion into adjacent organs or localized recurrence. Better diagnostics, reconstructive options and centralized care have reduced associated morbidity considerably, and it is still used rarely in palliative settings. Despite this, there is sparse prospective evidence reporting on long-term oncological or quality of life outcomes.
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Affiliation(s)
- Colla Cunneen
- Centre for Colorectal Disease, Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin
| | - Michael Kelly
- Centre for Colorectal Disease, Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin
| | - Gregory Nason
- Department of Urology, Mater University Hospital, Dublin, Ireland
| | - Eanna Ryan
- Centre for Colorectal Disease, Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin
| | - Ben Creavin
- Centre for Colorectal Disease, Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin
| | - Des Winter
- Centre for Colorectal Disease, Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin
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Kroon HM, Dudi-Venkata N, Bedrikovetski S, Thomas M, Kelly M, Aalbers A, Abdul Aziz N, Abraham-Nordling M, Akiyoshi T, Alberda W, Andric M, Antoniou A, Austin K, Baker R, Bali M, Baseckas G, Bednarski B, Beets G, Berg P, Beynon J, Biondo S, Bordeianou L, Brunner M, Buchwald P, Burger J, Burling D, Campain N, Chan K, Chang G, Chew M, C Chong P, Christensen H, Codd M, Colquhoun A, Corr A, Coscia M, Coyne P, Creavin B, Damjanovic L, Daniels I, Davies M, Davies R, de Wilt J, Denost Q, Dietz D, Dozois E, Duff M, Eglinton T, Enriquez-Navascues J, Evans M, Fearnhead N, Frizelle F, Garcia-Granero E, Garcia-Sabrido J, Gentilini L, George M, Glynn R, Golda T, Griffiths B, Harris D, Evans M, Hagemans J, Harji D, Heriot A, Hohenberger W, Holm T, Jenkins J, Kapur S, Kanemitsu Y, Kelley S, Keller D, Kim H, Koh C, Kok N, Kokelaar R, Kontovounisios C, Kusters M, Larson D, Law W, Laurberg S, Lee P, Lydrup M, Lynch A, Mantyh C, Mathis K, Martling A, Meijerink W, Merkel S, Mehta A, McDermott F, McGrath J, Mirnezami A, Morton J, Mullaney T, Mesquita-Neto J, Nielsen M, Nieuwenhuijzen G, Nilsson P, O'Connell P, Palmer G, Patsouras D, Pellino G, Poggioli G, Quinn M, Quyn A, Radwan R, Rasheed S, Rasmussen P, Regenbogen S, Rocha R, Rothbarth J, Roxburgh C, Rutten H, Ryan É, Sagar P, Saklani A, Schizas A, Schwarzkopf E, Scripcariu V, Shaikh I, Shida D, Simpson A, Smart N, Smith J, Solomon M, Sørensen M, Steele S, Steffens D, Stocchi L, Stylianides N, Tekkis P, Taylor C, Tsarkov P, Tsukamoto S, Turner W, Tuynman J, van Ramshorst G, van Zoggel D, Vasquez-Jimenez W, Verhoef C, Verstegen M, Wakeman C, Warrier S, Wasmuth H, Weiser M, Wheeler J, Wild J, Yip J, Winter D, Sammour T. Palliative pelvic exenteration: A systematic review of patient-centered outcomes. Eur J Surg Oncol 2019; 45:1787-1795. [PMID: 31255441 DOI: 10.1016/j.ejso.2019.06.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/02/2019] [Accepted: 06/07/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Palliative pelvic exenteration (PPE) is a technically complex operation with high morbidity and mortality rates, considered in patients with limited life expectancy. There is little evidence to guide practice. We performed a systematic review to evaluate the impact of PPE on symptom relief and quality of life (QoL). METHODS A systematic review was conducted according to the PRISMA guidelines using Ovid MEDLINE, EMBASe, and PubMed databases for studies reporting on outcomes of PPE for symptom relief or QoL. Descriptive statistics were used on pooled patient cohorts. RESULTS Twenty-three historical cohorts and case series were included, comprising 509 patients. No comparative studies were found. Most malignancies were of colorectal, gynaecological and urological origin. Common indications for PPE were pain, symptomatic fistula, bleeding, malodour, obstruction and pelvic sepsis. The pooled median postoperative morbidity rate was 53.6% (13-100%), the median in-hospital mortality was 6.3% (0-66.7%), and median OS was 14 months (4-40 months). Some symptom relief was reported in a median of 79% (50-100%) of the patients, although the magnitude of effect was poorly measured. Data for QoL measures were inconclusive. Five studies discouraged performing PPE in any patient, while 18 studies concluded that the procedure can be considered in highly selected patients. CONCLUSION Available evidence on PPE is of low-quality. Morbidity and mortality rates are high with a short median OS interval. While some symptom relief may be afforded by this procedure, evidence for improvement in QoL is limited. A highly selective individualised approach is required to optimise the risk:benefit equation.
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Tobias-Machado M, Lopes LS, de Araujo FBC, Starling ES, Pompeo ACL. Long-term experience on laparoscopic incontinent urinary diversion unrelated to cystectomy in radiated or recurrent pelvic malignancies. J Minim Access Surg 2013; 9:3-6. [PMID: 23626412 PMCID: PMC3630714 DOI: 10.4103/0972-9941.107121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 03/02/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND: There are few reports describing series of cases about development on laparoscopic urinary diversions no related to cystectomy. The aim of this paper is to show the experience of our reference institutions for treatment of pelvic malignancies when laparoscopic techniques were applied to perform only urinary diversion without cystectomy or pelvic exenteration. MATERIALS AND METHODS: We included retrospectively 12 cases of cutaneous ureterostomy and 21 cases with a reservoir (16 ileal conduits, 2 colonic conduits and 3 wet colostomies) treated in our institute from 2004 to 2010. It was evaluated operative time, blood loss, intraoperative complications, conversion rate, length of large incision, post operative complications, analgesic consumption, time to food intake, hospital stay, time to recovery to normal activities. Mean time to follow-up was 3(2-7) years.
RESULTS: All procedures were completed without conversions. In the cutaneous ureterostomy group the mean surgical time.
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Affiliation(s)
- Marcos Tobias-Machado
- Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), Av. Principe de Gales, 821 Santo Andre Sao Paulo CEP, Brazil
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