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Hawke JA, Regora S, Rajkomar A, Heriot A, Mohan H, Warrier S. Radical resection of locally advanced and recurrent colorectal carcinoma involving major nerve resection: a systematic review of surgical, oncological and functional outcomes. Int J Colorectal Dis 2024; 39:135. [PMID: 39162828 PMCID: PMC11335830 DOI: 10.1007/s00384-024-04707-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND The aim of this study was to explore the surgical, oncological and quality of life outcomes in the setting of radical resection of colorectal carcinoma involving major nerve resection. METHODS A systematic review of the literature was registered with the International Prospective Register for Systematic Reviews (PROSPERO) and performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify papers relating to outcomes in radical resection of colorectal cancer where major nerve resection was undertaken. Papers were identified from OVID Medline, EMBASE Classic and Web of Science encompassing all publications in English from January 2010 to June 2023. A total of 1357 nonduplicate studies were identified and screened for relevance, with six studies included in the final review. RESULTS A total of 354 major nerve resections were undertaken across the six included studies. Overall postoperative morbidity was reported at rates of up to 82%. Two studies considered nerve-resection-specific oncological outcomes, with complete pathological resection achieved at rates comparable to the wider pelvic exenteration cohort (65-68%) and without any overall survival disadvantage being conveyed by major nerve resection (p = 0.78). Two studies considered functional outcomes and noted a transient decrease in physical quality of life over the first 6 months postoperatively (p = 0.041) with significant loss to follow-up. One study considered postoperative pain in nerve resection and noted no significant increase in patient-reported pain scores associated with nerve resection (p = 0.184-0.618). CONCLUSIONS Major nerve resections in locally advanced and recurrent colorectal cancer remain understudied but with encouraging initial oncological and functional outcomes. Multicentre collaborative prospective reviews are needed to better elucidate contributors to postoperative morbidity and functional deficits and further establish interventions to ameliorate them.
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Affiliation(s)
- Justin A Hawke
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia.
| | | | - Amrish Rajkomar
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
- Epworth Healthcare, Richmond, VIC, Australia
| | - Alexander Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
- Epworth Healthcare, Richmond, VIC, Australia
| | - Helen Mohan
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
| | - Satish Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
- Epworth Healthcare, Richmond, VIC, Australia
- Monash University, Clayton, VIC, Australia
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S V, Pareekutty NM, Balasubramanian S. Outcomes Following Treatment of Pelvic Exenteration for Rectal Cancer in a Tertiary Care Center. Indian J Surg Oncol 2024; 15:420-427. [PMID: 38741635 PMCID: PMC11088593 DOI: 10.1007/s13193-024-01918-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 03/01/2024] [Indexed: 05/16/2024] Open
Abstract
Pelvic exenteration is potentially curative for operable locally advanced primary and locally recurrent rectal cancers. R0 resection is associated with higher survival. This procedure is associated with low mortality rates but high postoperative morbidity proportional to the extent of resection. This study was done to find out the survival outcome and morbidity associated with this procedure and to determine prognostic factors associated with postoperative outcomes. Seventy-three patients with rectal cancer underwent pelvic exenteration between January 2009 and December 2020. Sixty-six patients had locally advanced rectal cancer and 7 patients had recurrent cancer. All patients with primary tumors were evaluated with MRI pelvis and CT scan of the chest and abdomen while patients with recurrence were evaluated with a PET scan. The median follow-up duration was 39 months. The majority of patients were in the age group 40-69 years. Thirty patients were males and 43 were females. The 30-day postoperative major morbidity was reported in 28 patients (38.4%). The most common morbidity was wound dehiscence. The mean overall survival (OS) was 110.6 months (95% CI, 97.5-123.7) and mean disease free survival (DFS) was 85 months (95% CI, 71.0-100.4). R0 resection was associated with favorable overall survival. Tailored exenterations were associated with low morbidity. En bloc partial sacrectomy helped achieve R0 resection in patients who underwent the procedure. Extended resections yielded high R0 resection rates with favorable survival (65 months) but were associated with high morbidity. These procedures shall be best practiced in high-volume institutes of expertise. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-024-01918-w.
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Affiliation(s)
- Vijayasarathy S
- Department of Surgical Oncology, Malabar Cancer Center, Moozhikkara (PO), Thalassery, Kannur District, Kerala, 670103 India
| | - Nizamudheen M. Pareekutty
- Department of Surgical Oncology, Malabar Cancer Center, Moozhikkara (PO), Thalassery, Kannur District, Kerala, 670103 India
| | - Satheesan Balasubramanian
- Department of Surgical Oncology, Malabar Cancer Center, Moozhikkara (PO), Thalassery, Kannur District, Kerala, 670103 India
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Denys A, Thielemans S, Salihi R, Tummers P, van Ramshorst GH. Quality of Life After Extended Pelvic Surgery with Neurovascular or Bony Resections in Gynecological Oncology: A Systematic Review. Ann Surg Oncol 2024; 31:3280-3299. [PMID: 38459419 DOI: 10.1245/s10434-023-14649-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/09/2023] [Indexed: 03/10/2024]
Abstract
BACKGROUND Extended pelvic surgery with neurovascular or bony resections in gynecological oncology has significant impact on quality of life (QoL) and high morbidity. The objective of this systematic review was to provide an overview of QoL, morbidity and mortality following these procedures. METHODS The registered PROSPERO protocol included database-specific search strategies. Studies from 1966 onwards reporting on QoL after extended pelvic surgery with neurovascular or bony resections for gynecological cancer were considered eligible. All others were excluded. Study selection (Rayyan), data extraction, rating of evidence (GRADE) and risk of bias (ROBINS-I) were performed independently by two reviewers. RESULTS Of 349 identified records, 121 patients from 11 studies were included-one prospective study, seven retrospective studies, and three case reports. All studies were of very low quality and with an overall serious risk of bias. Primary tumor location was the cervix (n = 78, 48.9%), vulva (n = 30, 18.4%), uterus (n = 21, 12.9%), endometrium (n = 15, 9.2%), ovary (n = 8, 4.9%), (neo)vagina (n = 3, 1.8%), Gartner duct/paracolpium (n = 1, 0.6%), or synchronous tumors (n = 3, 1.8%), or were not reported (n = 4, 2.5%). Bony resections included the pelvic bone (n = 36), sacrum (n = 2), and transverse process of L5 (n = 1). Margins were negative in 70 patients and positive in 13 patients. Thirty-day mortality was 1.7% (2/121). Three studies used validated QoL questionnaires and seven used non-validated measurements; all reported acceptable QoL postoperatively. CONCLUSIONS In this highly selected patient group, mortality and QoL seem to be acceptable, with a high morbidity rate. This comprehensive study will help to inform eligible patients about the outcomes of extended pelvic surgery with neurovascular or bony resections. Future collaborative studies can enable the collection of QoL data in a validated, uniform manner.
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Affiliation(s)
- Andreas Denys
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Sofie Thielemans
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Rawand Salihi
- Department of Gynecology and Obstetrics, Ghent University Hospital, Ghent, Belgium
- Department of Gynecology and Obstetrics, AZ St. Lucas Hospital, Ghent, Belgium
| | - Philippe Tummers
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Gynecology and Obstetrics, Ghent University Hospital, Ghent, Belgium
| | - Gabrielle H van Ramshorst
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium.
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.
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Casey L, Larach JT, Waters PS, Kong JCH, McCormick JJ, Heriot AG, Warrier SK. Application of minimally invasive approaches to pelvic exenteration for locally advanced and locally recurrent pelvic malignancy - A narrative review of outcomes in an evolving field. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:2330-2337. [DOI: 10.1016/j.ejso.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 07/26/2022] [Accepted: 08/05/2022] [Indexed: 11/28/2022]
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Kazi M, Sukumar V, Desouza A, Saklani A. State-of-the-art surgery for recurrent and locally advanced rectal cancers. Langenbecks Arch Surg 2021; 406:1763-1774. [PMID: 34341869 DOI: 10.1007/s00423-021-02285-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023]
Abstract
Extended and beyond total mesorectal excisions (TME) for advanced and recurrent rectal cancers are increasingly performed with acceptable oncological and functional outcomes. These are undoubtedly due to better understanding of tumor biology and improved patient selection rather than surgical valor and technical refinements alone. In the present review, we attempt to present the current surgical standards for advanced and recurrent cancers requiring surgery outside the TME planes based on involved pelvic compartments. The available procedures, their indications, and extent of resection and reconstruction are highlighted. Emphasis is on formation of dedicated exenteration teams, structured training, and referral systems that increase hospital and surgeon volume to improve patient outcomes and reduce morbidity. Areas of deficiencies in literature were recognized with regards to factors influencing recurrences, patient selection, and quality of life. Finally, the most appropriate preoperative therapy for these tumors is unclear in both the primary and recurrent settings.
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Affiliation(s)
- Mufaddal Kazi
- Division of Colorectal Surgical Oncology, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, 400012, India
| | - Vivek Sukumar
- Division of Colorectal Surgical Oncology, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, 400012, India
| | - Ashwin Desouza
- Division of Colorectal Surgical Oncology, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, 400012, India
| | - Avanish Saklani
- Division of Colorectal Surgical Oncology, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, 400012, India.
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Feasibility and short-term outcome of laparoscopic pelvic lymph node dissection in rectal cancer at an University Center. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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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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Hogan S, Solomon M, Rangan A, Ferrie S, Carey S. The Impact of Preoperative Immunonutrition and Standard Polymeric Supplements on Patient Outcomes After Pelvic Exenteration Surgery, Taking Compliance Into Consideration: A Randomized Controlled Trial. JPEN J Parenter Enteral Nutr 2019; 44:806-814. [PMID: 31531997 DOI: 10.1002/jpen.1709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The effect of immunonutrition vs standard polymeric nutrition in the preoperative phase on patient outcomes is still unclear, which could be due to contributing factors such as poorly reported compliance and unequal provision of protein, energy, and volume. The aim of this study was to examine the effects of preoperative immunonutrition compared with standard polymeric supplements matched for energy, protein, volume, length of stay, and postoperative complications in pelvic exenteration surgery, taking into consideration compliance. METHODS This was a single-blinded, randomized, controlled trial in patients undergoing pelvic exenteration surgery. Fifty-two participants were randomly assigned to consume 3 immunonutrition supplements/d for 5 days preoperatively, and 56 participants were randomly assigned to consume 3 standard polymeric supplements/d for 5 days preoperatively. Primary and secondary outcome measures were assessed. Compliance with each nutrition regime was recorded during the intervention, and subanalysis was conducted. RESULTS There was no significant difference between immunonutrition and standard polymeric supplements on length of stay (P = 0.988) or postoperative complications (P = 0.179) after pelvic exenteration surgery. Compliance with nutrition supplements was significantly less in malnourished (n = 33) compared with well-nourished participants (n = 74) (P = 0.016). Compliance varied between study groups, although not significant. CONCLUSION Preoperative immunonutrition did not significantly impact length of stay or postoperative complications compared with standard polymeric supplements after pelvic exenteration surgery, despite controlling for protein, energy, and volume. Compliance, protein, and energy may considerably impact the effect of immunonutrition, particularly in malnourished patients.
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Affiliation(s)
- Sophie Hogan
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Michael Solomon
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Anna Rangan
- University of Sydney, Sydney, New South Wales, Australia
| | - Suzie Ferrie
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Sharon Carey
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
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Anatomical Variations of Iliac Vein Tributaries and Their Clinical Implications During Complex Pelvic Surgeries. Dis Colon Rectum 2019; 62:809-814. [PMID: 31188181 DOI: 10.1097/dcr.0000000000001335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND During high sacrectomies and lateral pelvic compartment exenterations, isolating the external and internal iliac veins within the presacral area is crucial to avoid inadvertent injury and severe hemorrhage. Anatomical variations of external iliac vein tributaries have not been previously described, whereas multiple classifications of internal iliac vein tributaries exist. OBJECTIVE We sought to clarify the iliac venous system anatomy using soft-embalmed cadavers. DESIGN This is a descriptive study. SETTINGS This study was conducted in Chulalongkorn University, Thailand. PATIENTS We examined 40 iliac venous systems from 20 human cadavers (10 males, 10 females). INTERVENTIONS Blue resin dye infused into the inferior vena cava highlighted the iliac venous system, which was meticulously dissected and traced to their draining organs. MAIN OUTCOME MEASURES Iliac vein tributaries and their valvular system were documented and analyzed. RESULTS The external iliac vein classically receives 2 tributaries (inferior epigastric and deep circumflex iliac) near the inguinal ligament. However, external iliac vein tributaries in the presacral area were found in 20 venous systems among 15 cadavers (75%). The mean diameter of each tributary was 4.0 ± 0.35 mm, with 72% arising laterally. We propose a simplified classification for internal iliac vein variations: pattern 1 in 12 cadavers (60%) where a single internal iliac vein joins a single external iliac vein to drain into the common iliac vein; pattern 2 in 7 cadavers (35%) where the internal iliac vein is duplicated; and pattern 3 in 1 cadaver (5%) where bilateral internal iliac veins drain into a common trunk before joining the common iliac vein bifurcation. LIMITATIONS This study is limited by the number of cadavers included. CONCLUSIONS A comprehensive understanding of previously unreported highly prevalent external iliac vein tributaries in the presacral region is vital during complex pelvic surgery. A simplified classification of internal iliac vein variations is proposed. See Video Abstract at http://links.lww.com/DCR/A900.
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Kim SR, Lee YY, Brar H, Albert A, Covens A, Metser U, May T. Utility of 18F-FDG-PET/CT imaging in patients with recurrent gynecological malignancies prior to pelvic exenteration. Int J Gynecol Cancer 2019; 29:ijgc-2018-000091. [PMID: 30923081 DOI: 10.1136/ijgc-2018-000091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/28/2018] [Accepted: 12/01/2018] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In patients with recurrent gynecologic malignancies isolated to the pelvis, pelvic exenteration is a potential option. 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT), is often used to confirm no evidence of metastatic disease. OBJECTIVE To assess the impact of PET/CT on clinical management of patients with recurrent gynecologic malignancies being considered for pelvic exenteration. METHODS Patients with recurrent gynecological malignancies who underwent PET/CT imaging between 2011 and 2014 were identified. All were considered for pelvic exenteration and underwent conventional imaging with CT +/- pelvic MRI. Patient anthropometric data, disease sites, histology, stage, treatment received, and treatment plan based on PET/CT findings were extracted. RESULTS A total of 40 patients met inclusion criteria. In 15 (37.5%) of these patients, results of PET/CT changed the original plan of pelvic exenteration owing to metastatic disease/unresectability (11/15) or no evidence of disease on PET/CT imaging (4/15). Twenty-five (62.5%) patients had their planned surgery after PET/CT with 19 (76%) patients undergoing a completed exenteration procedure. Six (24%) patients with PET/CT indicating isolated pelvic recurrence ultimately had intra-operative findings of extra-pelvic metastasis or nodal disease and therefore the planned surgery was aborted. CONCLUSION In nearly 40% of patients with recurrent gynecologic malignancies being considered for radical salvage surgery, PET/CT can significantly alter the originally intended treatment and hence may reduce the number of futile surgical procedures.
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Affiliation(s)
- Soyoun Rachel Kim
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Yoo-Young Lee
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Division of Gynecologic Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Harinder Brar
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Division of Gynecologic Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Arianne Albert
- Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Allan Covens
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ur Metser
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Taymaa May
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Division of Gynecologic Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
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CT findings after pelvic exenteration: review of normal appearances and most common complications. Radiol Med 2019; 124:693-703. [PMID: 30806919 DOI: 10.1007/s11547-019-01009-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
Abstract
The aim of this review is to illustrate normal computed tomography (CT) findings and the most common complications in patients who underwent pelvic exenteration (PE) for advanced, persistent or recurrent gynecological cancers. We review the various surgical techniques used in PE, discuss optimal CT protocols for postsurgical evaluation and describe cross-sectional imaging appearances of normal postoperative anatomic changes as well as early and late complications. The interpretation of abdominopelvic CT imaging after PE is very challenging due to remarkable modifications of normal anatomy. After this radical pelvic surgery, the familiarity with expected CT appearances is crucial for diagnosis and appropriate management of potentially life-threatening complications in patients who underwent PE.
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12
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Helewa RM, Park J. Surgery for Locally Advanced T4 Rectal Cancer: Strategies and Techniques. Clin Colon Rectal Surg 2016; 29:106-13. [PMID: 27247535 PMCID: PMC4882171 DOI: 10.1055/s-0036-1580722] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Locally advanced T4 rectal cancer represents a complex clinical condition that requires a well thought-out treatment plan and expertise from multiple specialists. Paramount in the management of patients with locally advanced rectal cancer are accurate preoperative staging, appropriate application of neoadjuvant and adjuvant treatments, and, above all, the provision of high-quality, complete surgical resection in potentially curable cases. Despite the advanced nature of this disease, extended and multivisceral resections with clear margins have been shown to result in good oncological outcomes and offer patients a real chance of cure. In this article, we describe the assessment, classification, and multimodality treatment of primary locally advanced T4 rectal cancer, with a focus on surgical planning, approaches, and outcomes.
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Affiliation(s)
- Ramzi M. Helewa
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Jason Park
- Section of Surgical Oncology, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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Lakhman Y, Nougaret S, Miccò M, Scelzo C, Vargas HA, Sosa RE, Sutton EJ, Chi DS, Hricak H, Sala E. Role of MR Imaging and FDG PET/CT in Selection and Follow-up of Patients Treated with Pelvic Exenteration for Gynecologic Malignancies. Radiographics 2016; 35:1295-313. [PMID: 26172364 DOI: 10.1148/rg.2015140313] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Pelvic exenteration (PE) is a radical surgical procedure used for the past 6 decades to treat locally advanced malignant diseases confined to the pelvis, particularly persistent or recurrent gynecologic cancers in the irradiated pelvis. The traditional surgical technique known as total PE consists of resection of all pelvic viscera followed by reconstruction. Depending on the tumor extent, the procedure can be tailored to remove only anterior or posterior structures, including the bladder (anterior exenteration) or rectum (posterior exenteration). Conversely, more extended pelvic resection can be performed if the pelvic sidewall is invaded by cancer. Preoperative imaging evaluation with magnetic resonance (MR) imaging and fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is central to establishing tumor resectability and therefore patient eligibility for the procedure. These imaging modalities complement each other in diagnosis of tumor recurrence and differentiation of persistent disease from posttreatment changes. MR imaging can accurately demonstrate local tumor extent and show adjacent organ invasion. FDG PET/CT is useful in excluding nodal and distant metastases. In addition, FDG PET/CT metrics may serve as predictive biomarkers for overall and disease-free survival. This pictorial review describes different types of exenterative surgical procedures and illustrates the central role of imaging in accurate patient selection, treatment planning, and postsurgical surveillance.
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Affiliation(s)
- Yulia Lakhman
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Stephanie Nougaret
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Maura Miccò
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Chiara Scelzo
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Hebert A Vargas
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Ramon E Sosa
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Elizabeth J Sutton
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Dennis S Chi
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Hedvig Hricak
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Evis Sala
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
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Kelly ME, Courtney D, Nason GJ, Winter DC. Exenterative Surgery for Advanced Prostate Cancer. CURRENT SURGERY REPORTS 2014. [DOI: 10.1007/s40137-014-0070-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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