Current developments for pelvic exenteration in gynecologic oncology

Schneider, Achim; Köhler, Christian; Erdemoğlu, Evrim

doi:10.1097/gco.0b013e32831c8436

Cited by 29 publications

(18 citation statements)

References 29 publications

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“…2,[6][7][8] In particular, they have examined time to hernia development, patient co-morbidity, the impact of specific treatment (e.g., with or without mesh). 9,10 However, since many gynecologic cancer patients are immuno-compromised, present with extensive disease or are susceptible to wound dehiscence, they may be at greater risk for a post-operative ventral site hernia.…”

Section: Introductionmentioning

confidence: 99%

Chemotherapy and patient co-morbidity in ventral site hernia development

et al. 2009

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Objective:The risk factors associated with early ventral site hernia development following cancer surgery are ill defined and associated with an undetermined incidence. Methods: We analyzed 1,391 gynecologic cancer patient charts to identify the number of post-operative ventral site hernias over a nearly 6 year period. The following study variables were noted for evaluation: patient demographics, disease co-morbidity (hypertension, cardiovascular disease, diabetes), body mass index (BMI), treatment (e.g., chemotherapy regimen), intra-operative (e.g., bleeding) and postoperative (e.g., infection) complications, time to hernia development and length of hospital stay. Results: Twenty-six gynecologic cancer patients who developed a post-operative ventral hernia and subsequently underwent herniorrhaphy by our gynecologic oncology service were identified. The patient group's overall time to initial hernia development was 11.23 months. Following a multiple regression analysis, we found that treatment (e.g., bevacizumab, liposomal doxorubicin or radiotherapy associated with compromised wound healing [p=0.0186] and disease co-morbidity [0.0432]) were significant prognostic indicators for an accelerated time to hernia development. Moreover, five patients underwent treatment associated with compromised wound healing and also had disease co-morbidity. In this sub-group, post-operative hernia development occurred more rapidly (3.8 months) than the overall group of patients. BMI and age did not impact time to hernia development (p＞0.05). Conclusion:In the present gynecologic cancer patient series, a tendency for early post-operative hernia development appeared to coincide with treatment associated with compromised wound healing and disease co-morbidity. Gynecologic cancer surgeons should anticipate this potential complication and consider employing prophylactic intra-operative mesh to potentially prevent this condition.

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Section: Introductionmentioning

confidence: 99%

Chemotherapy and patient co-morbidity in ventral site hernia development

et al. 2009

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“…Especially because of the ubiquitous use of laparoscopy in advanced urological disease and diseases calling for visceral surgery, the interdisciplinary approach permits the clinician to utilize the advantages of minimally invasive surgery (37). The use of robotic surgery for the treatment of ovarian cancer is a debated issue, but should be viewed in the same context as the laparoscopic operation.…”

Section: Application In Malignant Gynecological Diseasementioning

confidence: 99%

Robotic surgery in gynecology

Alkatout

Mettler

Maass

et al. 2016

J Turkish German Gynecol Assoc

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Review 224 Robotic surgery in gynecologyRobotic surgery is a dynamic development for minimally invasive procedures. The specialty of gynecology consistently offers new opportunities for innovative surgical techniques and the advancement of existing therapy approaches (Figure 1). Ever since the American FDA granted approval of the Da Vinci operation robot for gynecological operations in 2005, about three million robotic operations have been performed worldwide. 3500 Da Vinci systems are currently in use: 586 of these in Europe and 77 in Germany (4 th quarter of 2015). According to the figures of Intuitive Surgical, about 600,000 interventions were performed on a worldwide basis in the year 2014, of which 50% were performed in gynecology, approximately 30% in urology, and about 20% in general and chest surgeries. In 2011, the proportion of robotic hysterectomies performed for benign indications in the USA was as high as 27% (1). Currently, we have experience in robotic surgery for the majority of gynecological operations and fields of application. The known advantages of minimally invasive surgery, such as less blood loss, shorter durations of hospital stay, and lower patient morbidity compared to open procedures, have been observed here as well. Better exposure of the operating field by 3D technology and the extension of surgical instruments to 7 degrees of freedom permit the use of minimally invasive surgery, even for complex indications. Robot-assisted manipulation of the instruments permits tremor-free handling and reduces work fatigue for the surgeon, which is very advantageous for the surgeon as well as the patient in long and complex interventions. The possibility of working simultaneously on two parallel consoles shortens the learning curve, reduces complication rates, and facilitates the training of surgeons (2). The advancement of robotic surgery in terms of the Da Vinci Xi permits the variable use of optics in all four trocars (paraaortic lymphadenectomy, omentectomy, or interdisciplinary surgery in the upper abdomen can be performed without re-docking) and ensures markedly greater flexibility due to the optimized geometry of the so-called patient cart. Robotic surgery has been criticized for the fact that it requires the use of larger trocars compared to conventional laparoscopy, and is therefore associated with more numerous and larger cosmetic scars; this is avoided by the smaller trocars now used in robotic surgery (3). The development of the single-site systems signifies further new options for the gynecological surgeon (Figure 2). For instance, freedom of movement is now maximized by the introduction of one or more additional working trocars (4, 5). The low level of postoperative pain appears to be another advantage. It is accompanied by a lesser need for analgesics and even shorter hospital stays compared to traditional laparoscopic surgery. One explanation could be the fact that the abdominal wall need not be used as a counter bearing. The absence of irritation and the advantage of tissue protec...

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“…Literatūros duomenimis, atliekant radikalią dubens ekscenteracinę operaciją, 5 metų išgyvenamumas siekia nuo 22 iki 62% [4,8,[10][11][12][13][14]17,22,[24][25][26][27]. Paliatyvi dubens eksenteracija išlieka didelė etinė dilema, nes 5 metų išgyvenamumas po operacijos siekia 27% [34]. Tokia operacija turetų būti atliekama siekiant pagerinti gyvenimo kokybę, jei kiti gydymo metodai nėra efektyvūs [9].…”

Section: Diskusijaunclassified

Dubens Eksenteracinės Operacijos – Ultraradikalios Operacijos Klaipėdos Universitetinėje Ligoninėje

Šiaulys¹,

Domarkaitė

Tarachovskij

2014

Sveikatos Mokslai

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Raktažodžiai: dubens eksenteracinė operacija, chirurgija, recidyvo gydymas, komplikacijos. SantraukaTyrimo tikslas: apžvelgti ir išanalizuoti Klaipėdos universitetinės ligoninės patirtį atliekant dubens eksenteracines operacijas bei palyginti su literatūros duomenimis. Tyrimo metodai: retrospektyvinė apžvalga moterų, kurioms nuo 2011 m. gegužės mėn. iki 2013 m. gruodžio mėn. buvo atliktos dubens eksenteracinės operacijos. Įvertintos jų komplikacijos bei baigtys. Rezultatai: išanalizuota 8 ligonių duomenys. Vidutinis amžius -56,6 (36 -72) m. Vidutinis atkryčio laikas nuo pirminio naviko gydymo buvo apie 3,5 (0,5 -8) m. 7 moterims iš 8 dubens eksenteracinė operacija atlikta kaip radikalus, o 1 -paliatyvus gydymo metodas. Dažniausia indikacija operacijai buvo gimdos kaklelio vėžio recidyvas (62,5%). Iš 8 į studiją įtrauktų moterų 3 atliktos pilnos, 3 -priekinės ir 2 -užpakalinės dubens eksenteracinės operacijos. 1 atlikta infralevatorinė rezekcija, likusioms 7 -supralevatorinės rezekcijos. Vidutinė operacijos trukmė -306,25 (210 -370) min. Radikaliai operaciją pavyko atlikti 75% moterų (n=6). Nebuvo nei vieno mirties atvejo po operacijos hospitalizacijos metu. Vidutinis hospitalizacijos laikas -23,375 (14-51) dienos. Komplikacijos ankstyvuoju pooperaciniu periodu išryškėjo 37,5% (n =3) pacienčių. Vė-lyvų komplikacijų pasitaikė 50% moterų (n=4). Per mūsų studijos stebėjimo laikotarpį buvo vienas mirties atvejis dėl ligos progresavimo ir vienas mirties atvejis dėl miokardo infarkto. Ligos progresavimas diagnozuotas 37,5% pacienčių (n=3). Dviem iš jų dubens eksenteracinė operacija atlikta neradikaliai. Po dubens eksenteracinės operacijos 3 moterims taikyta chemoterapija. Išvados: 1. Dubens eksenteracinė operacija išlie- [1,3,6,9,[11][12][13][14][15][16][17][18]. Ankščiau dubens eksenteracinė operacija buvo atliekama tik esant gimdos kaklelio centriniams recidyvams. Dabar indikacijos išsiplėtė: operaciją galima atlikti ir esant šoniniams recidyvams, jei tik įmanoma radikaliai pašalinti naviką [10,27]. Retai ši ultraradikali operacija yra atliekama kaip pirminis ar kaip paliatyvus gydymo metodas [1]. DUBENS EKSENTERACINĖS OPERACIJOS -ULTRARADIKALIOSDubens eksenteracinė operacija pagal santykį su gimda horizontalioje ašyje yra skirstoma į: pilną, priekinę ir užpakalinę. Pilna dubens eksenteracinė operacija susideda iš šlapimo pūslės pašalinimo, histerektomijos (su pilna ar daline kolpektomija) ir tiesiosios žarnos pašalinimo. Priekinė atliekama, kai pašalinama šlapimo pūslė ir gimda (su pilna ar daline kolpektomija). Užpakalinė -tai tiesios žar-nos (su ar be išeinamosios angos), riestinės žarnos paša-linimas ir histerektomija (su pilna ar daline kolpektomija) [14,17,19,31] (1 paveikslas). Yra išskiriami 2 operacijos etapai: destrukcija, kai pašalinamas navikas su aplinkiniais audiniais, ir rekonstukcija,kai atkuriamas šlapimo nutekė-jimas ir išmatų pasišalinimas. Atliekant priekinę eksenteracinę operaciją, reikalinga suformuoti ureterostomą, o atliekant užpakalinę -kolostomą [14,27,31]. Dubens eksenteracinė operacija da...

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Current developments for pelvic exenteration in gynecologic oncology

Cited by 29 publications

References 29 publications

Chemotherapy and patient co-morbidity in ventral site hernia development

Chemotherapy and patient co-morbidity in ventral site hernia development

Robotic surgery in gynecology

Dubens Eksenteracinės Operacijos – Ultraradikalios Operacijos Klaipėdos Universitetinėje Ligoninėje

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