Sagittal pubic osteotomy in the investigation and treatment of intrapelvic neoplasia in the dog

Abstract

Sagittal pubic osteotomy was used as the surgical approach in 24 cases of intrapelvic neoplasia in the dog. Thirteen cases involved the urethra, seven cases the colorectum, one case the prostate and three cases the iliac periosteum. Surgical excision was performed in 10 cases of urethral neoplasia, four cases of rectal neoplasia, two cases of periosteal fibrosarcoma and one case of chondrosarcoma. The remaining cases were assessed as inoperable due to the extent of disease and euthanasia was carried out. Access to intrapelvic structures via a caudal midline laparotomy, perineal or dorsal routes or via an episiotomy is severely limited. The structures within the pelvic canal most likely to require surgical attention are the urethra, rectum and prostate. Procedures which require wide excision, accurate anastomotic techniques or relocation of intrapelvic organs necessitate an approach that allows generous exposure. A simple method of pubic osteotomy has been employed which has allowed resection of intrapelvic neoplasms.

Complications and outcomes following rectal pull-through surgery in dogs with rectal masses: 74 cases (2000–2013)

“…The inability to confirm intra-abdominal metastasis is a limitation of the RPT procedure 4,9 and highlights the need for appropriate preoperative staging, including thoracic radiography, abdominal ultrasonography, and aspiration of any abnormal lymph nodes. Metastasis was diagnosed in 4 dogs at the time of surgery, and metastasis or multicentric disease in the sublumbar lymph nodes was suspected for 6 dogs with rectal carcinoma, 1 dog with rectal MCT, and 1 dog with rectal lymphoma.…”

“…1,[3][4][5][6][7][8][9][10][11][12] For dogs with rectal masses, RPT surgery should be performed only after an informed discussion with the owner, including the risk of complications (both transient and permanent), the impact these complications may have on quality of life, and oncological outcomes. The high complication rate, particularly the rate of development of permanent fecal incontinence (23/74 [31.1%]), associated with RPT surgery might reasonably be considered a justification for not performing the procedure.…”

“…[3][4][5][6] Thus, several approaches have been described, including the ventral approach, dorsal inverted-U approach, pull-out or rectal mucosal eversion with submucosal resection, endoscopic electrosurgical resection, and RPT (transanal or combined abdominaltransanal) approach. [7][8][9] The major perceived drawback to this approach is that it involves an invasive technique to achieve adequate exposure of the diseased tissue; however, results of multiple studies [7][8][9] indicate that dogs develop minimal complications and rapidly return to ambulation following osteotomy. [7][8][9] The major perceived drawback to this approach is that it involves an invasive technique to achieve adequate exposure of the diseased tissue; however, results of multiple studies [7][8][9] indicate that dogs develop minimal complications and rapidly return to ambulation following osteotomy.…”

“…1,[3][4][5][6][7][8][9][10][11][12] The ventral approach involves either a sagittal pubic osteotomy or bilateral pubic and ischial osteotomies. In 1 study, 9 use of a sagittal pubic osteotomy via a ventral approach for treatment of dogs with rectal neoplasms generally resulted in a poor outcome, with 6 of 7 dogs developing postsurgical complications. The outcome of this approach for the treatment of dogs with rectal neoplasms is vari-able.…”

“…[7][8][9] The major perceived drawback to this approach is that it involves an invasive technique to achieve adequate exposure of the diseased tissue; however, results of multiple studies [7][8][9] indicate that dogs develop minimal complications and rapidly return to ambulation following osteotomy. However, the results of that study 9 should be interpreted with caution because 3 dogs had extensive metastatic lesions and were euthanized at the time of surgery and the other 3 dogs died of unknown causes. In 1 study, 9 use of a sagittal pubic osteotomy via a ventral approach for treatment of dogs with rectal neoplasms generally resulted in a poor outcome, with 6 of 7 dogs developing postsurgical complications.…”