Results of laparoscopic pelvic exenterations

Sanzharov A.E.; Gallyamov E.A.; Sergeev V.P.; Biktimirov R.G.; Aminova L.N.; Kochkin A.D.; Meshchankin I.V.; Agapov M.A.; Gololobov G.Yu.

doi:https://doi.org/10.17116/hirurgia202207145

Sanzharov A.E.

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

Gallyamov E.A.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-6359-0998

Sergeev V.P.

State Research Center of the Russian Federation — Burnazyan Federal Medical Biophysical Center

Biktimirov R.G.

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

Aminova L.N.

Botkin Clinical Hospital

Kochkin A.D.

Road Clinical Hospital

Meshchankin I.V.

MEDSI Clinical Hospital on Pyatnitskoe highway

Agapov M.A.

Lomonosov Moscow State University

Gololobov G.Yu.

Sechenov First Moscow State Medical University

Results of laparoscopic pelvic exenterations

Authors:

Sanzharov A.E., Gallyamov E.A., Sergeev V.P., Biktimirov R.G., Aminova L.N., Kochkin A.D., Meshchankin I.V., Agapov M.A., Gololobov G.Yu.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2022;(7): 45‑57

DOI: 10.17116/hirurgia202207145

Read: 2214 times

Download PDF (RU)

Contact the author

Table of contents

To cite this article:

Sanzharov AE, Gallyamov EA, Sergeev VP, et al. . Results of laparoscopic pelvic exenterations. Pirogov Russian Journal of Surgery. 2022;(7):45‑57. (In Russ.)
https://doi.org/10.17116/hirurgia202207145

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

Использование инфографики авторами научных работ

Close metadata

Abstract:

OBJECTIVE

To analyze clinical outcomes after pelvic exenteration for advanced primary or recurrent pelvic cancer.

MATERIAL AND METHODS

We analyzed the outcomes in 35 patients after pelvic exenteration for advanced primary or recurrent pelvic cancer (gynecological cancer, urologic cancers, colon cancer). There were 3 (8.57%) men and 32 (91.43%) women. Mean BMI was 26 kg/m².

RESULTS

Total exenteration was performed in 10 (28.57%) patients, anterior exenteration — 18 (51.43%) patients, posterior exenteration — 7 (20.0%) patients. Intraoperative complications (damage to the common iliac vessels) occurred in 1 (2.86%) patient. Mean surgery time was 280 minutes (range 180—600), mean intraoperative blood loss — 400 ml (range 100—2000). Mean postoperative ICU-stay was 24 hours. Major postoperative complications Clavien—Dindo grade 3—4 were detected in 3 (8.57%) patients. One (2.86%) patient died in 84 days after surgery from multiple organ failure due to progression of disease (Clavien—Dindo grade 5). There were 4 (11.43%) patients with complications Clavien—Dindo grade ≥3. Negative resection margin (R0) was achieved in 32 (91.43%) cases. The follow-up period ranged from 2 to 70 months (median 16.5 months). Overall survival was assessed in 25 patients. Other 10 patients or their relatives did not get in touch and therefore did not participate in assessment of survival. Overall 2-year survival assessed in 6 patients with cervical cancer was 24%. Overall 2-year survival estimated in 8 patients with bladder cancer was 100%. A patient with colon cancer lived for 23 months. Among 2 patients with vulvar cancer, 1 patient died in 25 months after surgery, the second one was followed-up for 11 months. Patients with primary multiple tumors were followed-up for 10—21 months. Overall 1-year survival was 100%. One patient died after 21 months.

CONCLUSION

Analyzing own findings and world literature data, we can conclude that laparoscopic technique ensures better intra- and postoperative results compared to standard laparotomy. However, there are insufficient data to confirm superiority of laparoscopic approach regarding oncological results.

Keywords:

pelvic exenteration

locally advanced pelvic cancer

recurrent pelvic cancer

multivisceral resection of pelvic organs

Authors:

Sanzharov A.E.

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

Gallyamov E.A.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-6359-0998

Sergeev V.P.

State Research Center of the Russian Federation — Burnazyan Federal Medical Biophysical Center

Biktimirov R.G.

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

Aminova L.N.

Botkin Clinical Hospital

Kochkin A.D.

Road Clinical Hospital

Meshchankin I.V.

MEDSI Clinical Hospital on Pyatnitskoe highway

Agapov M.A.

Lomonosov Moscow State University

Gololobov G.Yu.

Sechenov First Moscow State Medical University

Received:

24.01.2022

Accepted:

22.02.2022

Close metadata

References:

PelvEx Collaborative. Surgical and Survival Outcomes Following Pelvic Exenteration for Locally Advanced Primary Rectal Cancer: Results From an International Collaboration. Ann Surg. 2019;269(2):315-321. https://doi.org/10.1097/SLA.0000000000002528
Shirokorad VI. Surgical treatment of locally advanced tumors of the pelvic organs. M.: JSC Publishing house «Medicine», publishing house «Shiko»; 2008. (In Russ.).
Bizzarri N, Chiantera V, Ercoli A, Fagotti A, Tortorella L, Conte C, et al. Minimally Invasive Pelvic Exenteration for Gynecologic Malignancies: A Multi-Institutional Case Series and Review of the Literature. J Minim Invasive Gynecol [Internet]. 2019;26(7):1316-1326. https://doi.org/10.1016/j.jmig.2018.12.019
Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Heal. 2020;8(2):191-203. https://doi.org/10.1016/S2214-109X(19)30482-6
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. https://doi.org/10.3322/caac.21492
Rotman M, Sedlis A, Piedmonte MR, Bundy B, Lentz SS, Muderspach LI, et al. A phase III randomized trial of postoperative pelvic irradiation in Stage IB cervical carcinoma with poor prognostic features: follow-up of a gynecologic oncology group study. Int J Radiat Oncol Biol Phys. 2006;65(1):169-176. https://doi.org/10.1016/j.ijrobp.2005.10.019
Delgado G, Bundy B, Zaino R, Sevin BU, Creasman WT, Major F. Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: A Gynecologic Oncology Group study. Gynecol Oncol. 1990;38(3):352-357. https://doi.org/10.1016/0090-8258(90)90072-S
Yang TX, Morris DL, Chua TC. Pelvic exenteration for rectal cancer: A systematic review. Dis Colon Rectum. 2013;56(4):519-531. https://doi.org/10.1097/DCR.0b013e31827a7868
Nielsen M, Rasmussen P, Pedersen B, Hagemann-Madsen R, Lindegaard J, Laurberg S. Early and Late Outcomes of Surgery for Locally Recurrent Rectal Cancer: A Prospective 10-Year Study in the Total Mesorectal Excision Era. Ann Surg Oncol. 2015;22(8):2677-2684. https://doi.org/10.1245/s10434-014-4317-y
Brunschwig A. The surgical treatment of cancer of the cervix uteri; a radical operation for cancer of the cervix. Bull N Y Acad Med. 1948;24(10):672-683.
Brunschwig A, Daniel W. Pelvic exenteration operations: with summary of sixty-six cases surviving more than five years. Ann Surg. 1960;151:571-576. https://doi.org/10.1097/00000658-196004000-00018
Brown KGM, Solomon MJ, Koh CE. Pelvic exenteration surgery: The evolution of radical surgical techniques for advanced and recurrent pelvic malignancy. Dis Colon Rectum. 2017;60(7):745-754. https://doi.org/10.1097/DCR.0000000000000839
Sidorov DV, Alekseev BY, Lozhkin MV, Vorobyev NV, Petrov LO, Grishin NA, et al. 100 Small Pelvic Exenterations in Patients With Locally Advanced Primary and Recurrent Rectal Tumors. Onkol Zhurnal im. P.A. Gertsena. 2017;6(2):5-11. (In Russ.). https://doi.org/10.17116/onkolog2017625-11
Kostyuk IP, Vasilev LA, Krestyaninov SS. Classification of locally advanced pelvic tumors and secondary destruction of the bladder. Onkourologiâ. 2014;(1):39-43. (In Russ.).
Shostka KG, Pavlenko AN, Roman LD, Arutyunyan K V., Bogorodsky DY, Ilyin KS. Small pelvic eviscerations for colorectal cancer: Technical aspects and results. Onkol Zhurnal im. P.A. Gertsena. 2015;4(2):41-45. (In Russ.). https://doi.org/10.17116/onkolog20154241-45
Pavlov VN, Izmailov AA, Safiullin RI, et al. Pelvic exenteration in the complex treatment of locally advanced pelvic tumors. Medicinskij vestnik Bashkortostana. 2015;11:173-176. (In Russ.).
Shirokorad VI, Minaev II, Demin DI, Dolgikh VT. Method of surgical rehabilitation of patients after combined operations on the pelvic organs. Sibirskij nauchnyj medicinskij zhurnal. 2003;23(4):82-87. (In Russ.).
Loran OB, Seregin AV, Dovlatov ZA. Late results of treatment and quality of life in women after pelvic exenteration. Cancer Urology. 2016;12(1):36-41. (In Russ.). https://doi.org/10.17650/1726-9776-2016-12-1-36-41
Pomel C, Rouzier R, Pocard M, Thoury A, Sideris L, Morice P, et al. Laparoscopic total pelvic exenteration for cervical cancer relapse. Gynecol Oncol. 2003;91(3):616-618. https://doi.org/10.1016/j.ygyno.2003.08.032
Magrina JF. Types of pelvic exenterations: A reappraisal. Gynecol Oncol. 1990;37(3):363-366. https://doi.org/10.1016/0090-8258(90)90368-U
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):205-213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
Bacalbasa N, Balescu I, Vilcu M, Neacsu A, Dima S, Croitoru A, et al. Pelvic exenteration for locally advanced and relapsed pelvic malignancies — An analysis of 100 cases. In Vivo (Brooklyn). 2019;33(6):2205-2210. https://doi.org/10.21873/invivo.11723
Höckel M, Dornhöfer N. Pelvic exenteration for gynaecological tumours: achievements and unanswered questions. Lancet Oncol. 2006;7(10):837-847. https://doi.org/10.1016/S1470-2045(06)70903-2
Kelly ME, Ryan EJ, Aalbers AG, Abdul AN, Abraham-Nordling M, Alberda W, Antoniou A, Austin KK, Baker R, Bali M, Baseckas G. Pelvic Exenteration for Advanced Nonrectal Pelvic Malignancy. Ann Surg. 2019;270(5):899-905. https://doi.org/10.1097/SLA.0000000000003533
Ogura A, Akiyoshi T, Konishi T, Fujimoto Y, Nagayama S, Fukunaga Y, et al. Safety of Laparoscopic Pelvic Exenteration with Urinary Diversion for Colorectal Malignancies. World J Surg. 2016;40(5):1236-1243. https://doi.org/10.1007/s00268-015-3364-2
Uehara K, Nakamura H, Yoshino Y, Arimoto A, Kato T, Yokoyama Y, et al. Initial experience of laparoscopic pelvic exenteration and comparison with conventional open surgery. Surg Endosc. 2016;30(1):132-138. https://doi.org/10.1007/s00268-015-3364-2
Pavlov VN, Kabirov IR, Safiullin RI, Alekseev AV, Kapora EC. The first experience of robot-assisted evisceration of the small pelvis in locally advanced cervical cancer. Ural’skij medicinskij zhurnal. 2018;09(164):86-89. (In Russ.).
Robert E. Bristow DSC. Radical and Reconstructive Gynecologic Cancer Surgery. 2015.