2001, Number 4
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Cir Cir 2001; 69 (4)
Modification of the classical pelvic exenteration technique in patients with recurrence of cervical cancer after radiotherapy
Hernández-Aten D, Hernández-Naranjo MA, Mota-Gutiérrez MJ, Osuna-Aramburo M, Serrano OA
Language: Spanish
References: 25
Page: 167-172
PDF size: 80.52 Kb.
ABSTRACT
Background: Total pelvic exenteration consists of resection of all genital organs, bladder, rectum, and pelvic lymph nodes. Dr. A. Brunschwing introduced this procedure in 1948. Since then, it has gone through severe modifications to the original surgical technique. Dr. M. Bricker using the ileal conduct technique created the most important of these in 1951.
Objective: To evaluate the benefits of our suggested modifications for total pelvic exenteration in cases of recurrence of cervical cancer after radiotherapy.
Patients and Method: Twenty five patients with a recurrence of cervical cancer after radiotherapy underwent modified pelvic exenteration at the Oncology Service of the General Hospital of Mexico from January 1, 1993 to June 30, 1999. Modified pelvic exenteration consisted of 1) dissection of obturatriz fossa, 2) lymph node dissection of the level of iliac vessels and hypogastric plexus, and 3) installation of a peritoneal parietal patch on the urethral anastomosis.
Results: Twenty five modified pelvic exenterations were performed of which five (20%) were interior and 20 (80%), total. Mean age was 48 years, range 29 to 65. Urinary construction was performed with ileal conduct in 20 patients (80%) and sigmoid conduct in five (20%). Mean surgical time: 3.46 ± 0.18 minutes. Average transoperatory bleed: 970 ± 105 mL. Average blood transfusions during surgery 550 ± 55 mL. Hospital stay: 16 ± 2.88 days. Mean intensive care unit time: 6.9 ± 0.92 days. Early complications before 30 days were observed in four patients (16%) and later complications after 30 days in two patients (8%). Only one patient died (4%) due to septic shock. The modifications suggested in this study for the 0classic pelvic exenteration technique reduced the frequency of postoperative complications. It is necessary for our study to perform a random controlled trial to ascertain the benefits of these findings.
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