Outcomes After En Bloc Iliac Vessel Excision and Reconstruction During Pelvic Exenteration

Brown, Kilian G. M.; Koh, Cherry; Solomon, Michael J.; Qasabian, Raffi; Robinson, David; Dubenec, Steven

doi:10.1097/dcr.0000000000000421

Cited by 57 publications

(39 citation statements)

References 20 publications

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“…The surgery can be further categorized by pelvic compartment, or by the commonly used terminology of ‘total pelvic exenteration’ (removal of the rectum, pelvic reproductive organs and bladder), ‘anterior pelvic exenteration’ (removal of the reproductive organs and bladder, sparing the rectum) and ‘posterior pelvic exenteration’ (removal of the reproductive organs and rectum, sparing the bladder) . In some cases, the addition of en bloc resection of bone and/or pelvic sidewall structures is required to achieve a negative resection margin (R0) . The surgery is usually performed with the aim of treating locally advanced or recurrent pelvic malignancies.…”

Section: Introductionmentioning

confidence: 99%

Short‐ and long‐term outcomes of selective pelvic exenteration surgery in a low‐volume specialized tertiary setting

Humphries

Kroon

Dudi-Venkata

et al. 2019

ANZ Journal of Surgery

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Background: Most published data on pelvic exenteration comes from high-volume quaternary units, with limited data available from outside of this setting. This study reports outcomes of selective pelvic exenteration performed in a low-volume tertiary unit with multidisciplinary support. Methods: A retrospective review of consecutive patients who underwent pelvic exenteration surgery for rectal/anal carcinoma, or gynaecological malignancy at Royal Adelaide Hospital between June 2008 and September 2018. Descriptive statistics and Kaplan-Meier analysis of 5-year disease-free and overall survival for patients treated with curative intent were performed. Results: A total of 54 patients who underwent pelvic exenteration were included. Most patients presented with primary rectal adenocarcinoma, and posterior and total pelvic exenterations were the most common operations performed (>90%). Median total operating time was 323 min, median hospital stay was 15 days, and the readmission rate was 14.8%. The overall complication rate (per patient) was 70.4%, and the re-intervention rate was 20.4%. Thirteen percent of patients required intensive care unit-admission, and there was one postoperative death (1.9%). R0 resection margins were achieved in 81.5% of patients, with R1 and R2 margins in 13.0 and 5.6% of patients, respectively. Estimated 5-year disease-free survival was 38.8%, and 5-year overall survival was 65.7%. Conclusion: Short-and long-term outcomes of selective pelvic exenteration surgery are acceptable in a low-volume specialized tertiary setting with suitable multidisciplinary expertise. If the required expertise is not readily available, then outside referral is recommended.

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Section: Introductionmentioning

confidence: 99%

Short‐ and long‐term outcomes of selective pelvic exenteration surgery in a low‐volume specialized tertiary setting

Humphries

Kroon

Dudi-Venkata

et al. 2019

ANZ Journal of Surgery

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“…The combined radical resection of vessels in the treatment of locally re-recurrent colorectal tumors remains a significant problem. However, Brown et al reported that en bloc vascular resection and reconstruction for contiguous tumor involvement is feasible and safe in selected patients (4). Advanced pelvic tumors involving iliac vessels should not be precluded from curative surgery in specialized institutions.…”

Section: Discussionmentioning

confidence: 99%

Combined resection of re‐recurrent lateral lymph nodes and external iliac vein:Case Report and Literature

et al. 2018

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Herein, we describe the operative procedure for combined resection of re-recurrent lateral lymph nodes and the external iliac vein. There is no consensus on the clinical implications of resection of locally re-recurrent colorectal tumors, as the operative procedure is extremely difficult. We present the case of a 52-year-old woman who underwent abdominoperineal resection. About one year later, we excised a recurrent lymph node in the left lateral obturator area through an extraperitoneal approach. About 18 months later, lymph node re-recurrence in the left external iliac area was observed. Re-recurrent lymph nodes directly invade the left external iliac vein. We removed the re-recurrent lymph node with combined, radical segmental resection of the left external iliac vein, left obturator artery and vein, and left obturator nerve. J. Med. Invest. 65:136-138, February, 2018.

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“…Recent reports have shown the efficacy of en bloc resection of primary pelvic tumors involving main iliac vessels [ 28 , 29 ]. These reports suggested that surgery was feasibly performed in specialized institutions.…”

Section: Discussionmentioning

confidence: 99%

Surgical Resection with Neoadjuvant Chemotherapy for Locoregionally Recurrent Appendiceal Cancer Invading the External Iliac Vessels

Takahashi

Tsujinaka

Kakizawa

et al. 2018

Case Reports in Surgery

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Recent advancements in multimodal therapy can provide oncologic benefits for patients with recurrent colorectal cancer. This report presents a case of locoregionally recurrent appendiceal cancer treated with neoadjuvant chemotherapy followed by surgical resection with vascular reconstruction. A 68-year-old Japanese woman was diagnosed with appendiceal cancer and underwent ileocecal resection. The pathological evaluation revealed KRAS-mutant adenocarcinoma with the final stage of T4bN1M0. She received oral fluorouracil-based adjuvant chemotherapy. One year later, she was found to have peritoneal dissemination in the pelvic cavity and vaginal metastasis. She received an oxaliplatin-based chemotherapy followed by surgical resection. One year after the second surgery, she developed a locoregional recurrence involving the right external iliac vessels and small intestine. She received an irinotecan-based regimen with bevacizumab as neoadjuvant chemotherapy, followed by surgical resection. At first, a femoro-femoral bypass was made to secure the blood supply to the right lower extremities. Subsequently, an en bloc resection including the recurrent tumor and the external iliac vessels was completed. Surgical resection for recurrent colorectal cancer is often technically challenging because of the tumor location and invasion to adjacent organs. In this case, a surgical approach with persistent chemotherapy achieved oncologic resection of locoregionally recurrent appendiceal cancer.

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Outcomes After En Bloc Iliac Vessel Excision and Reconstruction During Pelvic Exenteration

Abstract: En bloc vascular resection and reconstruction for contiguous tumor involvement is feasible and safe in selected patients. Advanced pelvic tumors involving iliac vessels should not be precluded from curative surgery in specialized institutions.

Cited by 57 publications

References 20 publications

Short‐ and long‐term outcomes of selective pelvic exenteration surgery in a low‐volume specialized tertiary setting

Short‐ and long‐term outcomes of selective pelvic exenteration surgery in a low‐volume specialized tertiary setting

Combined resection of re‐recurrent lateral lymph nodes and external iliac vein:Case Report and Literature

Surgical Resection with Neoadjuvant Chemotherapy for Locoregionally Recurrent Appendiceal Cancer Invading the External Iliac Vessels

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