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Br J Radiol 2021 May 7:20201460. Epub 2021 May 7.

Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.

Pelvic exenteration (PE) is one of the most challenging gynecologic oncologic surgeries and is an overriding term for different procedures that entail radical en bloc resection of the female reproductive organs and removal of additional adjacent affected pelvic organs (bladder, rectum, anus, etc.) with concomitant surgical reconstruction to restore bodily functions. Multimodality cross-sectional imaging with MRI, PET/CT, and CT plays an integral part in treatment decision-making, not only for the appropriate patient selection but also for surveillance after surgery. Read More

J Plast Reconstr Aesthet Surg 2021 Mar 30. Epub 2021 Mar 30.

Department of Plastic Surgery, Norfolk and Norwich University Hospital, Norwich, UK; Department of Anatomy, Norwich Medical School, University of East Anglia, Norwich, UK.

The result of an extra-levator abdominoperineal excision of the rectum (ELAPE) is a composite three-dimensional defect. This is performed for locally advanced anorectal cancer, and may involve partial excision of the vagina. The aim of reconstruction is to achieve wound healing, restore the pelvic floor and to allow micturition and sexual function. Read More

Colorectal Dis 2021 Apr 30. Epub 2021 Apr 30.

The Norfolk and Norwich University Teaching Hospital, General Surgery, Norwich, UK.

Total pelvic exenteration is a radical operation which involves en bloc multi visceral resection of pelvic structures including bladder, rectum, sigmoid colon and the reproductive organs. It is commonly used in gnacological cancer surgery however indications extend to recurrent rectal cancer surgery including primary advanced and recurrent cancers. The operation is challenging and radical in its nature and requires Multiple surgical specialties operating at the same time including colorectal surgeons, gynaecologist, urologist and sometimes plastic surgeons as well. Read More

J Clin Med 2021 Apr 5;10(7). Epub 2021 Apr 5.

Department of Colorectal Surgery, Royal Marsden Hospital, London SW3 6JJ, UK.

Pelvic exenteration surgery for locally advanced rectal cancers is a complex and extensive multivisceral operation, which is associated with high perioperative morbidity and mortality rates. Significant technical challenges may arise due to inadequate access, visualisation, and characterisation of tissue planes and critical structures in the spatially constrained pelvis. Over the last two decades, robotic-assisted technologies have facilitated substantial advancements in the minimally invasive approach to total mesorectal excision (TME) for rectal cancers. Read More

Chirurg 2021 Apr 27. Epub 2021 Apr 27.

Plastisch- und Handchirurgische Klinik und Labor für Tissue Engineering und Regenerative Medizin, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, Krankenhausstraße 12, 91054, Erlangen, Deutschland.

In addition to the progressive development of surgical oncological techniques for malignant tumors of the rectum, anal canal and vulva, reconstructive procedures after oncological interventions in the perianal region represent a cornerstone in the postoperative quality of life of patients. Modern treatment modalities for rectal cancer with neoadjuvant chemoradiotherapy increase the survival rate and simultaneously reduce the risk of local recurrence to 5-10%, especially by cylindrical extralevatory extirpation of the rectum. The price for increased surgical radicality and improved oncological safety is the acceptance of larger tissue defects. Read More

Gynecol Oncol Rep 2021 May 31;36:100757. Epub 2021 Mar 31.

Department of Gynecology, Gynecological Oncology and Gynecological Endocrinology, University Hospital of Giessen and Marburg (UKGM), Marburg, Germany.

Pelvic exenterations are known to be a last resort therapeutic option for advanced or recurrent gynecologic malignancies, which are known to have poor prognosis. All women treated with anterior (APE) or total (TPE) pelvic exenteration at our University hospital within a five-year period were identified and their data retrospectively analysed. Parameters such as demographic information, tumor type and stage, previous therapy as well as complication rate and overall survival were evaluated. Read More

Eur J Surg Oncol 2021 Apr 17. Epub 2021 Apr 17.

Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia. Electronic address:

Introduction: Reporting of pelvic exenteration specimens for locally recurrent rectal cancer (LRRC) can be challenging for structured pathological analysis and currently, there is a lack of specific guidelines. The aim of this study was to assess the quality of pathology reporting in a cohort of patients who underwent pelvic exenteration for LRRC in a high-volume tertiary unit.

Materials And Methods: In a retrospective analysis of histopathology reports of consecutive patients who underwent pelvic exenteration for LRRC from 1996 to 2018, the quality of pathology reporting was assessed using the Structure Reporting Protocol for Colorectal Cancer. Read More

JPEN J Parenter Enteral Nutr 2021 Apr 21. Epub 2021 Apr 21.

Royal Prince Alfred Hospital, Sydney, NSW, Australia.

Background: Postoperative feeding practices vary after pelvic exenteration surgery due to the lack of nutrition research in this specific surgical area. Postoperative ileus is common after pelvic exenteration surgery and early enteral feeding is often avoided due to the lack of evidence and belief this may induce postoperative ileus in this patient cohort. The aim of this study was to determine the effects of early enteral feeding after pelvic exenteration surgery on return of bowel movement and postoperative ileus. Read More

Zhonghua Wei Chang Wai Ke Za Zhi 2021 Apr;24(4):352-358

Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China.

To investigate the impact of surgical treatment on quality of life in patients with locally recurrent rectal cancer (LRRC). A descriptive case series study was performed. The complete clinical data of 62 patients who met the diagnostic criteria of LRRC and treated by surgical procedures in Huashan Hospital of Fudan University from January 2012 to November 2019 were analyzed retrospectively. Read More

J Urol 2021 Apr 19:101097JU0000000000001784. Epub 2021 Apr 19.

Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas.

Purpose: According to the AUA/ASCO/ASTRO/SUO Guideline on treatment of nonmetastatic muscle-invasive bladder cancer (MIBC), females requiring radical cystectomy (RC) should undergo concomitant anterior pelvic exenteration despite low rates of malignant involvement of gynecologic organs. We present the clinicopathological characteristics of patients with MIBC treated with neoadjuvant chemotherapy (NAC) and evaluate the impact of NAC on gynecologic organ involvement (GOI).

Materials And Methods: An IRB approved review of patients with cT2-T3 MIBC treated with RC at our institution between 2005-2018 was performed. Read More

Urol Case Rep 2021 Jul 23;37:101654. Epub 2021 Mar 23.

UWA Medical School, The University of Western Australia, Crawley, WA, Australia.

Urethral adenocarcinoma (UA) is a rare type of urethral cancer with a poor prognosis. We present a case of UA of intestinal subtype in a 57-year-old patient who initially had lower urinary tract symptoms and was subsequently found to have a urethral lesion in a urethral diverticulum on pelvic MRI which was confirmed on biopsy. She had neoadjuvant chemotherapy followed by open anterior pelvic exenteration, complete urethrectomy and ileal conduit urinary diversion. Read More

Nutr Health 2021 Apr 15:2601060211009067. Epub 2021 Apr 15.

2205Royal Prince Alfred Hospital, Australia.

Background: Preoperative malnutrition is common in surgical oncology patients and can have negative effects on postoperative outcomes. Pelvic exenteration is major surgery associated with high morbidity rates. Associations between preoperative malnutrition, determined using the patient-generated subjective global assessment, and postoperative outcomes in this patient cohort has not yet been investigated. Read More

Br J Surg 2021 Apr 6. Epub 2021 Apr 6.

Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia.

Surg Oncol 2021 Mar 19;37:101546. Epub 2021 Mar 19.

Royal Prince Alfred Hospital, Department of Colorectal Surgery, Sydney, Australia; Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Sydney, Australia. Electronic address:

This review outlines the role of pelvic exenteration (PE) in the management of certain locally-advanced primary and recurrent rectal cancers. PE has undergone significant evolution over the past decades. Advances in pre-, intra-, and post-operative care have been directed towards achieving the 'holy grail' of an R0 resection, which remains the most important predictor of survival, quality of life, morbidity, and cost effectiveness following PE. Read More

ANZ J Surg 2021 Mar 26. Epub 2021 Mar 26.

Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

Ann Surg Oncol 2021 Mar 9. Epub 2021 Mar 9.

Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

Objective: To describe quality of life (QOL) and survival outcomes following pelvic exenteration (PE) in old and young patients.

Background: PE is a management option for complete resection in locally advanced pelvic cancers. Few studies have examined the impact of age on the outcome in elderly patients following PE. Read More

ANZ J Surg 2021 03;91(3):231-232

Surgical Outcomes Research Centre, University of Sydney & Sydney Local Health District, Sydney, New South Wales, Australia.

Langenbecks Arch Surg 2021 May 17;406(3):821-831. Epub 2021 Mar 17.

Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra, 400012, India.

Purpose: The aim was to evaluate the oncological outcomes and the prognostic factors following pelvic exenteration (PE) in cT4 and fixed cT3 stage primary rectal adenocarcinoma and to study the impact of consolidation chemotherapy following neoadjuvant concurrent chemoradiotherapy (NACRT).

Methods: A retrospective analysis of a prospectively maintained database of PE from 2013 to 2018.

Results: Out of 2900 colorectal resections, there were 131 pelvic exenterations that were performed, and 100 of these patients had undergone exenteration for primary rectal adenocarcinoma. Read More

Gynecol Oncol Rep 2021 May 11;36:100713. Epub 2021 Feb 11.

Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Eighty percent of women with ovarian cancer have advanced disease (FIGO stage III or IV) at the time of diagnoses and require extensive upper abdominal surgery to obtain complete gross resection (Minig et al., 2015, Eisenhauer et al., 2006). Read More

Asian J Endosc Surg 2021 Mar 15. Epub 2021 Mar 15.

Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.

Introduction: Herein, we describe our novel technique for transecting the dorsal venous complex (DVC) and urethra using a linear stapler inserted through a perineal port during endoscopic pelvic exenteration for pelvic malignancies.

Materials And Surgical Technique: First, a laparoscopic approach is made using a conventional 5-trocar pneumoperitoneum technique. When the Retzius and paravesical spaces are dissected to expose the tendinous arch of the levator ani muscle, the transperineal approach is synchronously begun. Read More

Int J Colorectal Dis 2021 Mar 7. Epub 2021 Mar 7.

Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.

Background: Pelvic exenteration (PE) is the only option for long-term cure of advanced cancer originating from different types of tumor or recurrent disease in the lower pelvis. The aim was to show differences between colorectal and non-colorectal cancer in survival and postoperative morbidity.

Methods: Retrospective data of 63 patients treated with total pelvic exenteration between 2013 and 2018 are reported. Read More

Gynecol Oncol Rep 2021 May 13;36:100728. Epub 2021 Feb 13.

Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koutouku, Tokyo 135-8550, Japan.

In 2003, Höckel described the laterally extended endopelvic resection (LEER), which may be an effective surgical technique for patients with laterally recurrent cervical cancer (Höckel, 2003). Super-radical hysterectomy, which was introduced by Ryukichi Mibayashi in 1941, is the traditional surgical approach for cervical cancer patients (Kim et al., 2017). Read More

Ann Surg Oncol 2021 Mar 2. Epub 2021 Mar 2.

Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia.

Int J Gynecol Cancer 2021 Mar 1. Epub 2021 Mar 1.

Department of Gynaecological Oncology, St. James's Hospital, Dublin, Ireland

J Obstet Gynaecol 2021 Mar 1:1-9. Epub 2021 Mar 1.

Gynaeoncology Department, Royal Marsden Hospital, London, UK.

The objective of this study is to evaluate the role of laparoscopy in the case selection of patients for pelvic exenteration to treat recurrent cervical or endometrial cancer. Pelvic exenteration is a rare surgical procedure performed by specialised multidisciplinary surgical teams. We performed a review of 55 consecutive laparoscopies for patients being evaluated for possible exenterative surgery for recurrent cervical or endometrial cancer at a single centre in the UK with a significant exenterative surgical practice. Read More

Dis Colon Rectum 2021 May;64(5):e100-e101

Department of Colorectal Surgery and Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia, Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium (current affiliation) Surgical Outcomes Research Centre and Institute of Academic Surgery, Royal Prince Alfred Hospital and, School of Public Health, University of Sydney, Sydney, New South Wales, Australia Department of Colorectal Surgery, Surgical Outcomes Research Centre, and Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

Dis Colon Rectum 2021 May;64(5):e99

Plastic Surgery Unit, Department of Surgery, NSCB Government Medical College, Jabalpur (MP) India Department of Surgery, NSCB Government Medical College, Jabalpur (MP) India.

Int J Surg Case Rep 2021 Mar 9;80:105629. Epub 2021 Feb 9.

Department of Plastic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.

Introduction: Limited literature exists regarding the positional relationship between the pedicled-rectus abdominis myocutaneous (p-RAMC) flap and residual pelvic organs post posterior pelvic exenteration (PPE).

Presentation Of Case: Four patients underwent PPE and reconstruction with a p-RAMC flap. After harvesting the p-RAMC flap with the deep inferior epigastric artery and veins as the vascular pedicle, the intra-pelvic shortest pathway of the flap was created. Read More

BJS Open 2021 Jan;5(1)

Background: The multidisciplinary perioperative and anaesthetic management of patients undergoing pelvic exenteration is essential for good surgical outcomes. No clear guidelines have been established, and there is wide variation in clinical practice internationally. This consensus statement consolidates clinical experience and best practice collectively, and systematically addresses key domains in the perioperative and anaesthetic management. Read More

Gan To Kagaku Ryoho 2021 Feb;48(2):242-244

Dept. of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine.

Patient is 69-year-old man, who underwent a high anterior resection with laparoscopic support for rectal cancer. The patient was diagnosed with anastomotic recurrent rectal cancer after 14 months after surgery. The pelvic MRI scan showed invasion of the prostate and seminal vesicles, so NACRT was performed. Read More