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Группа авторов. Surgical Management of Advanced Pelvic Cancer
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Surgical Management of Advanced Pelvic Cancer
List of Contributors
Preface
1 From Early Pioneers to the PelvEx Collaborative
Background
The Pioneers
Brunschwig’s Operation
Evolution in Pelvic Exenterative Surgery. Urinary Reconstruction
The Koenig–Rutzen Bag
Evolution of the Uretero‐Ileal Conduit
Subspecialization and Partial Exenteration
Composite Pelvic Exenterations
Lateral Pelvic Sidewall Resection
Perineal Reconstruction
Future Directions
References
2 The Role of the Multidisciplinary Team in the Management of Locally Advanced and Recurrent Rectal Cancer
Background
Complex Pelvic Cancer MDTM
Staging, Restaging, and Pathological Assessment. Staging
Restaging
Pathological Assessment
Complex Cancer MDTM Outcomes
Summary Box
References
3 Preoperative Assessment of Tumor Anatomy and Surgical Resectability
Background
Cancer Anatomy and Resectability
Radiological Assessment of Cancer Anatomy by MRI
Case Study
Radiological Assessment of Metastatic Disease
Summary Box
References
4 Neoadjuvant Therapy Options for Advanced Rectal Cancer
Background
Potential Advantages of TNT
Potential Disadvantages of TNT
Short‐Term Outcomes. Pathological Response
Long‐Term Oncological Outcomes
Organ Preservation
Chemotherapy and Compliance
Novel Chemotherapeutic Agents
Immunotherapeutics
Locally Recurrent Rectal Cancer
Future Developments
Summary Box
References
5 Preoperative Optimization Prior to Exenteration
Background
Clinical Examination
Laboratory Tests
Risk Assessment of Morbidity and Mortality
Preoperative Optimization
Anemia Management
Optimization of Nutritional Status
Mechanical Bowel Preparation and Oral Antibiotic Prophylaxis
Thromboprophylaxis
Stoma Education
Summary Box
References
6 Patient Positioning and Surgical Technology
Background
Operating Room Setup
General Room Setup
Adjuncts to Operating Room Setup
Robotic Room Setup
Patient Positioning
Modified Lloyd‐Davies
Jackknife Prone
Complications Associated with Patient Positioning
Surgical Equipment and Energy Devices
Summary Box
References
7 Intraoperative Assessment of Resectability and Operative Strategy
Background
The Preoperative Phase. Planning. Multidisciplinary Team
Operating Environment
Personnel
Core Teams
Regular Participants
Occasional Contributors
The Intraoperative Stage
External Examination
General Laparotomy
Summary Box
References
8 Anterior Pelvic Exenteration
Background
Diagnostics Specific to Anterior Pelvic Exenteration
Surgical Procedure
Anesthesia and Starting the Procedure
Urological Approach
Gynecological Approach
Rectal Cancer
Ureter Dissection
Lateral Compartment
Partial Cystectomy
Partial Prostatectomy
Uterus and Vaginal Wall
Urinary Diversion (Ileal Conduit)
Urinary Diversion (Colon Conduit)
Morbidity and Mortality
Morbidity
Mortality
Complications
Survival
Quality of Life Following Anterior Pelvic Exenteration
Sexual Dysfunction
Urinary Dysfunction
General and Mental Health
Summary Box
References
9 Posterior Pelvic Exenteration
Background
Preoperative Assessment
Intraoperative Decision‐Making
Surgical Technique
Mobilization of Left Colon and Upper Rectum
Isolation of Ureters
Mobilization of Uterus Including Adnexa
Dissection of Internal Iliac Artery
Dissection of Obturator Foramen and Anterior Approach to Sciatic Nerve
Summary Box
References
10 Total Pelvic Exenteration
Background
Indications
Who Should Be Performing these Procedures? Selecting the Right Team and Plan
Specialist Centers
Getting Patients Right – Fitness for Surgery (Prehabilitation)
Preoperative Planning
Examination under Anesthesia/Flexible Sigmoidoscopy/Colonoscopy
Neoadjuvant Therapy
Surgical Technique
Uterus and Vagina Involvement
Anterior Recurrences: Beyond the Normal Planes
Posterior Compartment and Extended Bony Resections
Lateral Pelvic Recurrences
Intraoperative Radiation Therapy
Reconstruction
Adjuncts to Care: Urinary and Sexual Function and Ostomy Placement
Summary Box
References
11 Extended Exenterative Resections Involving Bone
Background
Anatomical Considerations
Sacral Resection
High Sacrectomy (S1/S2) Versus Low Sacrectomy (S3 and Below)
Anterior Pubic Resection
Lateral Pelvic Resection
Patient Workup Specific to Bony Resection
History and Examination
Radiology
Anesthetic Assessment
Multidisciplinary Meeting
Neoadjuvant treatment
Operative Technique
Surgical Approach
Technique for Sacrectomy
Reconstruction
Intraoperative Radiotherapy
Novel Approaches in Sacrectomy. Partial Anterior Sacrectomy
Laparoscopic Sacrectomy
Outcomes
Summary Box
References
12 Exenterative Resections Involving Vascular and Pelvic Sidewall Structures
Background
Anatomy
Vascular
Neurologic
Urologic and Gynecologic
Muscular
Preoperative Evaluation. Imaging
Functional Status
Informed Consent
Intraoperative Management. Preparation and Positioning
Equipment
Operative Approach
Postoperative Management
Complications
Summary Box
References
13 Extended Exenterative Resections for Recurrent Neoplasm
Background
Strategies for Tackling Involvement of Posterior Compartment Including Sacrum
Low Sacrectomy
High Sacrectomy
Perineal Closure
Strategies for Tackling Involvement of Pelvic Sidewall
Strategies for Tackling Involvement of Anterior Compartment
Summary Box
References
14 Pelvic Exenteration in the Setting of Peritoneal Disease
Background
Treatment Options of Colorectal Peritoneal Metastases
Pelvic Exenteration, Cytoreductive Surgery, and HIPEC
Summary Box
References
15 Minimally Invasive Pelvic Exenteration
Background
History of Minimally Invasive Pelvic Exenterative Surgery
Rectal Cancer Beyond TME
Advantages of a Robotic Approach to Exenteration
Surgical Planning and Reconstruction
Patient Factors
Disease Factors
Technical Factors
Robotic Surgical Approach
Outcomes
Future Directions
Summary Box
References
16 Stoma Considerations Following Exenteration
Background
Urinary Diversion
Incontinent Urinary Diversions. Ileal Conduit
Transverse Colon Urinary Diversion
Distal Colon Urinary Diversion
Direct Cutaneous Ureterostomy
Continent Urinary Diversions
Miami Pouch
Indiana Pouch
Uretero‐ileocecal Appendicostomy
Orthotopic Neobladder
Comparison of Continent and Incontinent Urinary Diversions
Urological Leaks
Fecal Diversion
Combined Fecal and Urinary Diversion. Wet Colostomy
Double‐Barreled Wet Colostomy
Parastomal Hernia
Future Developments
Summary Box
References
17 Reconstructive Techniques Following Pelvic Exenteration
Background
Bowel Reconstruction
Options
Urinary Tract Reconstruction
Ureteric Reimplantation
Urinary Diversion, Conduit, and Uretostomy
Reconstruction of Perineum
Omentum
Mesh
Pedicle Flaps
Fasciocutaneous Flaps
Myocutaneous Flaps and Free Flaps
Summary Box
References
18 Minimizing Morbidity from Pelvic Exenteration
Background
Knowing the Risks
Intraoperative Management. General Considerations. Surgical Safety Checklist
Anesthesia
Venous Thromboembolism Prophylaxis
Patient Positioning
Perioperative Surgical Site Infection Bundle
Urinary Catheters
Team Communication
Surgical Considerations
Major Hemorrhage
Preoperative Considerations
Intraoperative Considerations
Urological Surgical Considerations
Managing the Empty Pelvis
Stoma Formation
Postoperative Management. Critical Care
Venous Thromboembolic Prophylaxis
Enhanced Recovery after Surgery
Postoperative Complications. Early Complications
Cardiopulmonary complications
Postoperative Bleeding
Surgical Site Infection
Flap Complications
Prolonged ileus
Renal impairment
Urinary Leak
Stoma
Long‐Term Complications
Chronic Pain
Bowel Obstruction
Urological
Sexual Function
Incisional, Perineal, and Parastomal Hernia
Mental Health
Summary Box
References
19 Crisis Management
Background
Prior to Surgery
Intraoperative Management. Hemorrhage Control
Postoperative Hemorrhage
Nerve Damage
Obturator Nerve
Femoral Nerve
Sciatic Nerve
Sacralplexus
Injury to Bowel or Urinary Tract
Postoperative Management. Abdominal Compartment
Delayed Presentation of Bowel or Urinary Tract Injury
Massive Transfusion
Summary Box
References
20 Quality of Life and Patient‐Reported Outcome Measures Following Pelvic Exenteration
Background
Quality of Life and Patient‐Reported Outcomes Instruments
Quality of Life Trajectories Following Pelvic Exenteration
Gynecological Malignancies
Rectal Malignancy
Mixed Malignancies
Palliative Exenteration
Predictors of Postoperative Quality of Life
Patient‐Reported Outcome Measures Following Pelvic Exenteration
Future Directions
Summary Box
References
21 Adjuvant Therapy options after Pelvic Exenteration for Advanced Rectal Cancer
Background
Adjuvant Therapy
Novel Agents
Radiotherapy
Future Directions
Summary Box
References
22 Adjuvant Therapy Options after Pelvic Exenteration for Gynecological Malignancy
Background
Cervical Cancer
Vaginal Cancer
Vulval Cancer
Endometrial Cancer
Ovarian Cancer
Summary Box
References
23 Adjuvant Therapy Options for Urological Neoplasms
Background
Prostate Cancer. Radiation Therapy
Brachytherapy
Hormonal Therapy: Gonadotropin‐Releasing Hormone (GnRH) Analogs
Abiraterone Acetate
Enzalutamide
Chemotherapy
Second‐line Treatment for Metastatic Prostate Cancer
Bladder Cancer
Chemotherapy
Immunotherapy
Radiotherapy
Conclusion
Summary Box
References
24 The Role of Re‐irradiation for Locally Recurrent Rectal Cancer
Background
Treatment of Locally Recurrent Rectal Cancer
Morbidity After Re‐irradiation
Primary Outcome after Re‐irradiation for LRRC
Summary Box
References
25 Palliative Pelvic Exenteration
Background
Historical Perspective
Definition
Indications
Outcomes
Morbidity and Mortality
Symptom Relief
Quality of Life
Overall Survival
Future Directions
Summary Box
References
26 Outcomes of Pelvic Exenteration for Locally Advanced and Recurrent Rectal Cancer
Background
Tumor Biology and its Effect on Oncological Outcomes
Oncological Outcomes and Radiation Therapy
Outcomes of the Largest Pelvic Exenteration Series in the Literature
Mortality and Morbidity. Overall Mortality and Morbidity
Intraoperative Complications
Postoperative Complications
Neoadjuvant Treatment and Postoperative Complications
Hospital Stay
Summary Box
References
27 Outcomes Following Exenteration for Urological Neoplasms
Background
Prostate Cancer
Locally Advanced Disease
Advanced Prostate Cancer
Synchronous Prostate and Rectal Cancer
Bladder Cancer
Complications
Urological Leaks
Ileal Conduit
Orthotopic Bladder
Wet Colostomy
Palliative Exenterations
Quality of Life
Summary Box
References
28 Outcomes Following Exenteration for Gynecological Neoplasms
Background
Further Important Situations. Engagement of Pelvic Sidewalls
Para‐Aortic Lymph Nodes
Age and Comorbidity
Preoperative Workup Specific to Gynecological Neoplasms
Preoperative Planning and Counseling. Urinary Diversion
Bowel Continuity
Neovagina
Pelvic Floor Reconstruction
Complications
Survival and Quality of Life
Summary Box
References
29 Mesenchymal and Non‐Epithelial Tumors of the Pelvis
Background
Incidence
Etiology
Specific Diagnostics
Imaging
Biopsy
Staging Systems
Treatment
Benign Soft Tissue Tumors of the Pelvis. Lipoma/Pelvic Lipomatosis
Schwannoma
Desmoid‐Type Fibromatosis
Soft Tissue Sarcomas of the Pelvis
Liposarcoma
Leiomyosarcoma
Rhabdomyosarcoma
Malignant Peripheral Nerve Sheath Tumors
Solitary Fibrous Tumor
Epithelioid Sarcoma
Undifferentiated Pleomorphic Sarcomas
Benign Bone Tumors Involving the Pelvis
Osteochondroma
Ganglion Cyst
Aneurysmal Bone Cyst
Giant Cell Tumor
Osteoid Osteoma
Osteoblastoma
Malignant Bone Tumors of the Pelvis
Types of Resections
Osteosarcoma
Ewing’s Sarcoma
Chondrosarcoma
Chordoma
Summary Box
References
Index. a
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