Novel use of the Bakri balloon to minimize empty pelvis syndrome following laparoscopic total pelvic exenteration

AIM

Pelvic exenteration is the only surgical option for locally advanced pelvic malignancies infiltrating the surrounding organs. The resultant pelvic void after the procedure is responsible for a number of complications, collectively termed empty pelvis syndrome (EPS). We aim to show how EPS can be minimized by presenting a case series demonstrating the surgical technique of laparoscopic total pelvic exenteration with bilateral pelvic node dissection along with a novel use of the Bakri balloon.

METHOD

This is a case series of three successive patients undergoing laparoscopic total pelvic exenteration for locally advanced primary, nonmetastatic rectal adenocarcinoma over a period of 1 month in a specialized colorectal unit at a tertiary cancer centre. The Bakri balloon was deployed in all three patients and retained for variable time intervals postoperatively. Features of EPS were prospectively documented.

RESULTS

In the first patient, the Bakri balloon was completely deflated and removed on postoperative day (POD) 5. The patient developed subacute intestinal obstruction which resolved with conservative management by POD 12. In the second and third patients, the Bakri balloon was deflated in a sequential manner, beginning on POD 8, until it was finally removed on POD 11. Neither of these patients had any abdominal complaints. A postoperative CT scan of both these patients showed the small bowel loops clearly above the pelvic inlet.

CONCLUSIONS

The Bakri balloon is a simple, safe and cost-effective method to reduce the complications of EPS following laparoscopic total pelvic exenteration. A prospective study is ongoing to objectively quantify the benefits of this technique.

Intraperitoneal hyperthermic chemotherapy in ovarian cancer

We investigated the effect of intraperitoneal hyperthermic perfusion chemotherapy as consolidation therapy in stage IIIB-IIIC ovarian cancer, following cytoreductive surgery and systemic chemotherapy (cisplatin-cyclophosphamide--six cycles). Disease-free survival, overall survival, and side effects were compared with a control group of patients who refused a second-look surgery and intraperitoneal chemotherapy. In a multicenter prospective trial, 29 patients with complete or optimal cytoreductive surgery and systemic treatment were included in the consolidation group and received intraperitoneal hyperthermic perfusion chemotherapy. Patients were recruited between January 1991 and December 1997. The intraperitoneal hyperthermic perfusion was performed with open-abdomen technique, using physiologic solution containing cisplatin 100 mg/m2, for 60 min in hyperthermic phase (41-43 degrees C). Intraperitoneal hyperthermic perfusion chemotherapy was locally and systemically well tolerated. The consolidation therapy group showed a better 5-year survival rate and lower recurrent disease rate, but differences were not statistically significant. Our results suggest that intraperitoneal hyperthermic perfusion chemotherapy is a feasible, well-tolerated, and promising alternative as consolidation therapy in ovarian cancer.

Intraperitoneal hyperthermic chemotherapy in ovarian cancer

We investigated the effect of intraperitoneal hyperthermic perfusion chemotherapy as consolidation therapy in stage IIIB–IIIC ovarian cancer, following cytoreductive surgery and systemic chemotherapy (cisplatin–cyclophosphamide—six cycles). Disease-free survival, overall survival, and side effects were compared with a control group of patients who refused a second-look surgery and intraperitoneal chemotherapy. In a multicenter prospective trial, 29 patients with complete or optimal cytoreductive surgery and systemic treatment were included in the consolidation group and received intraperitoneal hyperthermic perfusion chemotherapy. Patients were recruited between January 1991 and December 1997. The intraperitoneal hyperthermic perfusion was performed with open-abdomen technique, using physiologic solution containing cisplatin 100 mg/m2, for 60 min in hyperthermic phase (41–43°C). Intraperitoneal hyperthermic perfusion chemotherapy was locally and systemically well tolerated. The consolidation therapy group showed a better 5-year survival rate and lower recurrent disease rate, but differences were not statistically significant. Our results suggest that intraperitoneal hyperthermic perfusion chemotherapy is a feasible, well-tolerated, and promising alternative as consolidation therapy in ovarian cancer.

Conservative treatment vs. mastectomy without radiotherapy in aged women with breast cancer--a prospective and randomized trial

OBJECTIVE

To determine whether tumorectomy with tamoxifen in women over 70 years achieves the same treatment results as mastectomy plus tamoxifen.

MATERIAL AND METHODS

Prospective randomized analysis of 121 patients over 70 with breast cancer clinically negative axilla and tumor up to 4 cm diameter. Randomization was according to even or odd birth month. Branch A: Madden operation + tamoxifen 20 mg OD (once/day). Branch B: Tumorectomy to disease free margins + tamoxifen 20 mg OD.

RESULTS

Survival rate of five years for the Madden operation was 69% and for tumorectomy 71.4% with a mortality from other causes of 23.1%. Survival probability (specific death) at 5 years was of 93.4% for the Madden group and 95.2% for tumorectomy. A significant increase of the mortality was observed in those patients that had recurrences, no matter of treatment given. Specific death cause did not vary with age, but did for other causes, this being significant.

CONCLUSIONS

Tumorectomy plus tamoxifen demonstrated to be as effective as Madden Op. plus tamoxifen in women over 70 years with T1-T2-N0 disease.