Colorectal function preservation in posterior and total supralevator exenteration for gynecologic malignancies: An 89-patient series

Institut Paoli Calmettes, Marsiglia, Provence-Alpes-Côte d'Azur, France
Gynecologic Oncology (Impact Factor: 3.77). 05/2003; 89(1):155-9. DOI: 10.1016/S0090-8258(03)00069-6
Source: PubMed


The objective of this study was to analyze our experience with colorectal function preservation at the time of pelvic exenteration.
Between January 1980 and December 2001, 201 pelvic exenterations for gynecologic malignancies were performed in our hospital. Ninety-eight were supralevator exenterations and 89 were selected for this study because low colorectal anastomosis (LCRA) was performed. There were locally advanced or recurrent cancers including 50 cervical, 28 ovarian, 11 endometrial, and 3 vaginal malignancies and 5 pelvic sarcomas.
Thirty-nine patients (44%) had a history of previous irradiation. There were were 50 posterior and 39 total exenterations. A diverting stomy and/or pelvic filling were performed respectively in 44 (49.4%) and 26 (29%) cases. The postoperative mortality rate was 4.5% (4/89). Seventeen patients experienced a colorectal anastomotic fistula (AF). AF occurred significantly more frequently in irradiated patients (14/17 = 82%). The mortality rate related to AF was 6% (1/17). Ultimately the functional colorectal anastomosis rate was 71.9%, respectively 61.5 and 80% in irradiated and nonirradiated patients.
Colorectal function preservation in supralevator exenteration for gynecologic malignancies can be achieved safely in a majority of patients. In irradiated patients a systematically diverting stomy may result in a low mortality rate.

4 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cervical cancer is the second most frequent cancer in women in the world. Surgery plays a major role, particularly in patients with early-stage disease. This review focuses on the evaluation of important papers published since January 2003 on the management of invasive cervical cancer. Patients are classified as having early-stage (stage IB1) or advanced-stage (stage IB2 or greater) disease. Several papers are devoted to the evaluation of prognostic factors in patients with early-stage disease and negative nodes. Several recurrences after radical trachelectomy have been reported that remind us that strict selection criteria are mandatory for conservative management. The development of sentinel node and laparoscopic procedures has gained momentum. For patients with advanced-stage disease, the place of staging procedures in para-aortic areas or pelvic surgery after chemoradiation therapy continues to be debated and is currently being investigated in randomized studies. Several papers also continue to debate surgical treatment modalities for recurrent disease (the place of laparoscopy and reconstructive surgery). Several interesting papers have been published since 2003 about the surgical treatment of cervical cancer. Laparoscopic surgery and the sentinel node procedure have developed considerably, particularly for the surgical management of early-stage disease. The results of ongoing studies are awaited to determine the value of pelvic surgery (after neoadjuvant treatment) in patients with advanced-stage disease.
    Current Opinion in Obstetrics and Gynecology 03/2005; 17(1):5-12. DOI:10.1097/00001703-200502000-00003 · 2.07 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this retrospective study was to analyze the long-term outcome of patients undergoing a continent urinary diversion (UD) at the time of pelvic exenteration (PE). Between February 1993 and January 2001, 60 PE for gynecologic malignancies and requiring a UD were performed. Patient's preference, type of UD planned, type of UD performed, and late urinary morbidity (after day 90) were analyzed. Eighty-two percent of the entire group (49/60) matched preoperatively criteria to have a continent UD and 41 continent UD were eventually performed (87%). Postoperative mortality in patients with a continent UD was 4.9% (2/41) and wasn't related to urinary complications. After a 20-month median follow-up, 18 patients (46%) with a continent UD developed late complications directly UD-related. These complications were: (a) major in 28% (5/18) requiring re-operation in 3 cases or endoscopic treatment in 2 cases; (b) minor in 72% (13/18) constantly medically treated. Chronic diarrhea was more frequent in patient who had small bowel or left colon resection (P < 0.05) and urine leakage was more frequent in patient with higher BMI (P < 0.05). At last follow-up, no patient had stopped self-catheterizations or asked for undiversion. In our experience, continent UD at the time of PE despite high acceptability and feasibility rate, appeared to be strongly related to specific late complications, uncommon with ileal conduit. However, these complications remained more frequently minor and could be treated safely and conservatively.
    Gynecologic Oncology 05/2005; 97(2):524-8. DOI:10.1016/j.ygyno.2004.12.009 · 3.77 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Review of reconstruction procedures following pelvic exenterations. Review article. Department of Obstetrics and Gynecology, Department of Urology, 1st Department of Surgery, Faculty Teaching Hospital and 1st Medical Faculty of the Charles University, Prague. Review and critical assessment of published data. Reconstruction procedures are important part of pelvic exenterations. The procedures are crucial for following quality of life. Currently the most frequently used techniques for isolated pelvic floor support are omental flaps (carpets), for combined reconstruction of pelvic floor and vagina TRAM (transverse rectus abdominis musculocutaneus flap). Reconstructions prolong operation time; however they are accompanied with low morbidity and some techniques decrease total morbidity of exenterative procedure. Total and posterior exenterations require sigmoideostomy in vast majority of cases. Low rectal anastomosis might be used in cases of supralevator procedures. They cause high morbidity especially in patients following radiotherapy. In these patients temporary diverting colostomy is being recommended. A bowel segment is usually used for urinary diversion following total or anterior exenteration. Golden standard remain the incontinent ureteroenterostomies using ileum or colon transversum. Currently continent diversions are considered more often due to encouraging results and good quality of life. Heterotopic diversions, with continent conduit and cutaneous stoma, are frequently used. Risk of serious complications, especially fistulas and stoma stenosis, after all types of diversions is possible to reduce by using appropriate bowel segment not handicapped by previous radiotherapy.
    Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne 06/2005; 70(3):205-10.
Show more

Similar Publications