Technique of the laparoscopic pelvic exenteration

Cover Page


Cite item

Full Text

Abstract

Background: Laparoscopic surgery has proved itself to be a “golden standard” for treatment of most abdominal and retroperitoneal cancers. Such a serious procedure as pelvic exenteration continues to be a complex surgical intervention usually performed through a  conventional laparotomic access. However, studies on minimally invasive approach for this intervention have becoming increasingly published in the world literature.

Aim: To describe the laparoscopic pelvic exenteration technique of pelvic exenteration, as well as to assess short- and long-term results of these interventions.

Materials and methods: From 2011 to 2018, 21 procedures of laparoscopic pelvic exenteration have been performed in 6  surgical centers (Moscow, Russia). Six (6) patients had previously confirmed cervical cancer, 7 patients had bladder cancer, 4 patients had rectal cancer, 1 patient had vaginal cancer, 2 patients had relapsing vaginal cancers after previous uterine extirpation, and 1 patient had an ovarian neoplasm.

Results: The laparoscopic pelvic exenteration volumes were as follows: 9  total, 7 anterior and 5 posterior procedures. In 19 out of 21 cases, negative resection margin (R0) was possible. Median duration of the procedure was 254 minutes, median blood loss was 515 ml, and median postoperative hospital stay was 13 days. Postoperative complications were registered in 6 (28.6%) patients. The 3-year overall survival was 85.71%.

Сonclusion: The choice of laparoscopic access can reduce blood loss, decrease the rates of early postoperative complications, contributes to a more comfortable postoperative period with early activation and less severe pain syndrome, and leads to a reduction in the duration of hospital stay. These results of the laparoscopic technique are comparable with those of laparoscopic and open pelvic exenteration published by other authors.

About the authors

E. A. Galliamov

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: fake@neicon.ru

Eduard A. Galliamov – MD, PhD, Professor, Head of the Chair of General Surgery.

8/2 Trubetskaya ul., Moscow, 119991

Россия

R. G. Biktimirov

Clinical Center of Advanced Medical Technologies of the Federal Medical and Biological Agency

Email: fake@neicon.ru

Rafael G. Biktimirov – MD, PhD, Head of the Department of Urology.

Mkr-n Novogorsk, Khimki, Moscow Region, 141435

Россия

V. P. Sergeev

State Research Center – Burnasyan Federal Medical Biophysical Center of the Federal Medical and Biological Agency

Email: fake@neicon.ru

Vladimir P. Sergeev – MD, Head of the Department of Oncological Urology.

23 Marshala Novikova ul., Moscow, 123098

Россия

L. N. Aminova

Joint Stock Company "Medsi group"

Email: fake@neicon.ru

Liana N. Aminova – MD, PhD, Head of Department of Gynecology.

5–3, 5–4 2-y Botkinskiy proezd, Moscow, 125284

Россия

A. E. Sanzharov

Federal Scientific and Clinical Center for Specialized Methods of Medical Care and Medical Technologies of the Federal Medical and Biological Agency

Email: fake@neicon.ru

Andrey E. Sanzharov – MD, Head of the Department of Urology.

28 Orekhovyy bul'var, Moscow, 115682

Россия

M. A. Agapov

Lomonosov Moscow State University Medical Research and Educational Center (Lomonosov University Clinic)

Email: fake@neicon.ru

Mikhail A. Agapov – MD, PhD, Professor, Head of the Department of Surgery No 1.

27/10 Lomonosovskiy prospekt, Moscow, 119991

Россия

D. I. Volodin

State Research Center – Burnasyan Federal Medical Biophysical Center of the Federal Medical and Biological Agency

Email: fake@neicon.ru

Denis I. Volodin – MD, Urologist, Department of Oncological Urology.

23 Marshala Novikova ul., Moscow, 123098

Россия

Е. E. Gallyamov

Federal Scientific and Clinical Center for Specialized Methods of Medical Care and Medical Technologies of the Federal Medical and Biological Agency

Email: fake@neicon.ru

Eduard E. Gallyamov – MD, Surgeon, Oncologist, Department of Urology.

28 Orekhovyy bul'var, Moscow, 115682

Россия

G. Yu. Gololobov

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: grriffan@gmail.com

Grigoriy Yu. Gololobov – MD, Surgeon, Department of Surgery.

19/1 Bol'shaya Pirogovskaya ul., Moscow, 119146, tel.: +7 (917) 738 86 89

Россия

References

  1. American Cancer Society. Cancer Fact & Figures 2017. Atlanta: American Cancer Society; 2017 [Internet]. Available from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2017/cancerfacts-and-figures-2017.pdf.
  2. Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg. 2010;97(11): 1638–45. doi: 10.1002/bjs.7160.
  3. PelvEx Collaborative. Factors affecting outcomes following pelvic exenteration for locally recurrent rectal cancer. Br J Surg. 2018;105(6): 650–7. doi: 10.1002/bjs.10734.
  4. Латыпов ВР, Дамбаев ГЦ, Попов ОС, Вусик АН. Результаты тазовой экзентерации у женщин, выполненной по поводу опухолевых поражений и осложнений лучевой терапии. Онкоурология. 2015;11(1): 55–63. doi: 10.17650/1726-9776-2015-1-55-63.
  5. Костюк ИП, Шестаев АЮ. Эвисцерация малого таза как метод выбора в лечении рецидива рака шейки матки. Вестник Российской военно-медицинской академии. 2012;(1): 280–5.
  6. Shindo M, Leitao MM, Gardner GJ, Jewell E, Chi DS, Abu-Rustum NR, Sonoda Y. Local cervical recurrence after radical trachelectomy for early-stage cervical cancer: Is completion hysterectomy necessary? Gynecol Oncol. 2017;145(Suppl 1): 193. doi: 10.1016/j.ygyno.2017.03.440.
  7. Костюк ИП, Васильев ЛА, Крестьянинов СС. Классификация местно-распространенных новообразований малого таза и вторичного опухолевого поражения мочевого пузыря. Онкоурология. 2014;10(1): 39–43. doi: 10.17650/1726-9776-2014-10-1-39-43.
  8. Лоран ОБ, Серегин АВ, Довлатов ЗА. Поздние результаты лечения и качество жизни после экзентерации органов таза у женщин. Онкоурология. 2016;12(1): 36–41. doi: 10.17650/1726-9776-2016-12-1-36-41.
  9. Hayashi K, Kotake M, Kakiuchi D, Yamada S, Hada M, Kato Y, Hiranuma C, Oyama K, Hara T. Laparoscopic total pelvic exenteration using transanal minimal invasive surgery technique with en bloc bilateral lymph node dissection for advanced rectal cancer. Surg Case Rep. 2016;2(1): 74. doi: 10.1186/s40792-016-0198-6.
  10. Ogura A, Akiyoshi T, Konishi T, Fujimoto Y, Nagayama S, Fukunaga Y, Ueno M. Safety of Laparoscopic Pelvic Exenteration with Urinary Diversion for Colorectal Malignancies. World J Surg. 2016;40(5): 1236–43. doi: 10.1007/s00268-015-3364-2.
  11. Quyn AJ, Austin KK, Young JM, Badgery-Parker T, Masya LM, Roberts R, Solomon MJ. Outcomes of pelvic exenteration for locally advanced primary rectal cancer: Overall survival and quality of life. Eur J Surg Oncol. 2016;42(6): 823–8. doi: 10.1016/j.ejso.2016.02.016.
  12. Uehara K, Nakamura H, Yoshino Y, Arimoto A, Kato T, Yokoyama Y, Ebata T, Nagino M. Initial experience of laparoscopic pelvic exenteration and comparison with conventional open surgery. Surg Endosc. 2016;30(1): 132–8. doi: 10.1007/s00464-015-4172-3.
  13. Rausa E, Kelly ME, Bonavina L, O'Connell PR, Winter DC. A systematic review examining quality of life following pelvic exenteration for locally advanced and recurrent rectal cancer. Colorectal Dis. 2017;19(5): 430–6. doi: 10.1111/codi.13647.
  14. van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ; COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14(3): 210–8. doi: 10.1016/S1470-2045(13)70016-0.
  15. Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, Choi HS, Kim DW, Chang HJ, Kim DY, Jung KH, Kim TY, Kang GH, Chie EK, Kim SY, Sohn DK, Kim DH, Kim JS, Lee HS, Kim JH, Oh JH. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol. 2014;15(7): 767–74. doi: 10.1016/S14702045(14)70205-0.
  16. Porpiglia F, Renard J, Billia M, Scoffone C, Cracco C, Terrone C, Scarpa RM. Open versus laparoscopy-assisted radical cystectomy: results of a prospective study. J Endourol. 2007;21(3): 325–9. doi: 10.1089/end.2006.0224.
  17. Vizza E, Pellegrino A, Milani R, Fruscio R, Baiocco E, Cognetti F, Savarese A, Tomao F, Chen C, Corrado G. Total laparoscopic radical hysterectomy and pelvic lymphadenectomy in locally advanced stage IB2-IIB cervical cancer patients after neoadjuvant chemotherapy. Eur J Surg Oncol. 2011;37(4): 364–9. doi: 10.1016/j.ejso.2010.12.001.
  18. Martínez-Gómez C, Angeles MA, Martinez A, Ferron G. Laparoscopic anterior pelvic exenteration in 10 steps. Gynecol Oncol. 2018;150(1): 201–2. doi: 10.1016/j.ygyno.2018.04.561.
  19. Kanao H, Aoki Y, Hisa T, Takeshima N. Total laparoscopic pelvic exenteration for a laterally recurrent cervical carcinoma with a vesicovaginal fistula that developed after concurrent chemoradiotherapy. Gynecol Oncol. 2017;146(2): 438–9. doi: 10.1016/j.ygyno.2017.05.030.
  20. Isla-Ortiz D, Montalvo-Esquivel G, Herrera-Goepfert RE, Herrera-Gómez Á, Salcedo-Hernández RA. Laparoscopic anterior pelvic exenteration in a patient with locally advanced melanoma. Cir Cir. 2017;85 Suppl 1:93–8. doi: 10.1016/j.circir.2016.10.012.
  21. Aiba T, Uehara K, Tsukushi S, Yoshino Y, Ebata T, Yokoyama Y, Igami T, Sugawara G, Nagino M. Perineal alveolar soft part sarcoma treated by laparoscopy-assisted total pelvic exenteration combined with pubic resection. Asian J Endosc Surg. 2017;10(2): 198–201. doi: 10.1111/ases.12342.
  22. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2): 205–13. doi: 10.1097/01.sla.0000133083.54934.ae.
  23. Сидоров ДВ, Алексеев БЯ, Ложкин МВ, Воробьев НВ, Петров ЛО, Гришин НА, Троицкий АА, Королев ПА, Мошуров РИ. Сто экзентераций малого таза при местно-распространенных первичных и рецидивных опухолях прямой кишки. Онкология. Журнал им. П.А. Герцена. 2017;6(2): 5–11. doi: 10.17116/onkolog2017625-11.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2018 Galliamov E.A., Biktimirov R.G., Sergeev V.P., Aminova L.N., Sanzharov A.E., Agapov M.A., Volodin D.I., Gallyamov Е.E., Gololobov G.Y.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies