Orbital exenteration for eyelid skin carcinoma

Exenteration of the orbit is a disfiguring and destructive procedure; it is generally performed for orbital malignancies and often provides a significant reconstructive challenge. Our purpose was to evaluate the clinical indications for orbital exenteration in a tertiary referral center and to assess the reconstructive options employed. A retrospective nonrandomized analysis was performed, selecting all patients undergoing orbital exenteration over a 5-year period, between January 2005 and January 2010. Patient demographics, tumor characteristics, and reconstructive techniques used were evaluated. Twenty patients with a mean age of 76.5?years underwent total orbital exenteration. Basal cell carcinoma was the main operative indication (45%), followed by squamous cell carcinoma (15%). Reconstructive techniques included cover of the raw orbital cavity with a temporal muscular flap in all cases followed with split skin grafting (25%), bilaterally pedicle V-Y advancement flap (10%) and a fasciocutaneous island flap of the retroauricular region (65%). Twenty percent of patients had local complications and all were treated in a satisfactory fashion. Eyelid skin tumors remain an important cause of orbital exenteration. Temporal muscle flap is a reliable and stable reconstructive solution after orbital exenteration and additional aid is supplied with skin grafts or local flaps. This technique ensures a good aesthetic outcome and better situation for later complementary treatments and minimal associated donor site morbidity.     

Orbital exenteration for advanced periorbital skin cancers: 20 years experience.

PURPOSE: Orbital exenteration is a disfiguring procedure that results in a significant deformity which poses a reconstructive challenge, especially in elderly patients with significant comorbidities. We reviewed our experience of orbital exenteration. METHODS: A retrospective analysis was conducted identifying all patients undergoing orbital exenteration over a 20-year period. Patient demographics, tumour characteristics and reconstructive techniques used were recorded. RESULTS: Thirty-two patients were treated by orbital exenteration. The majority of these were for basal cell carcinomas (53%). Most patients (62.5%) were ASA grade II or more. Reconstructive techniques included split skin grafting (63%), forehead (25%), scalp (6%) and cervicofacial (6%) flaps. Following reconstruction of the exenterated orbit, 29 patients had a prosthesis. Twenty-six of these rated their final result with their definitive prosthesis as good. CONCLUSIONS: Though there are various options available for reconstruction after orbital exenteration, a split skin graft and orbital prosthesis provide a simple solution for a very difficult problem of advanced periorbital skin cancer in the elderly population with significant comorbidities. The final outcome is comparable to that of more complex flap reconstruction with comparable satisfaction rates.     

Total pelvic exenteration in the treatment of advanced pelvic cancer

Total pelvic exenteration (TPE) is a radical and aggressive procedure performed in the local advanced pelvic cancer started from any pelvic organ. The experience of 73 TPE performed for local invasive cancer and centro-pelvic recurrences with initial malignancy at the cervix (45 cases), rectum (19 cases), vagina (5 cases), endometrial (3 cases) and urinary bladder (1 case), in 61 females and 12 males with age range 27-78 years, are analysed. The procedures were performed for advanced pelvic cancer in 24 cases and also for invasive centro-pelvic recurrences in 49 cases (67.5%). In 5 cases, TPE was extended laterally. In 42 patients reconstructive procedures were added. All patients survived to surgery but 5 postoperative deaths (6.8%) were recorded. Complications occurred in 52% of cases, 38 from 73 patients had one or more than one complication with an average of 1.5 per patient. 22 among these patients (30%) requiring operative treatment. The average survival was 49.07 months, the median survival of 55 months and the estimated survival at 11 and 78 months was 66%, respectively 50%. The procedure is indicated in the absence of pelvic wall invasion and secondary distant dissemination and lengthens significantly the life span and increase the quality of life.     

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目的 评价盆腔脏器联合切除术（PE）对局部进展期直肠癌的疗效。方法 对12年中79例局部进展期直肠癌PE术后结果进行回顾性总结。结果 全盆腔脏器切除术（TPE）46例，其中保肛TPE5例，TPE联合骶骨切除1例，TPE联合半骨盆切除1例，后盆腔脏器切除术（PPE）33例。根治性切除65例（82．8％），合并症发生率48．6％，手术死亡2例（2．5％），根治术后再复发36例（58．1％），术后1、3、5年生存率75．8％、39．3％、35．8％。根治性切除与大体根治切除术后3年、5年生存率分别为44．2％、40．8％与11．1％、0。结论 PE是目前治疗局部进展期直肠癌有效的方法，积极的根治性切除病灶，可以有效提高其治愈率，改善生活质量。     

A modified supralevator pelvic exenteration for the treatment of locally advanced rectal cancer with vaginal and uterine invasion

Post-chemoradiation T4 rectal cancer remains a therapeutic challenge and an aggressive surgical approach is the only chance for a cure. Rectal lesions infiltrating the upper vaginal wall and uterine cervix are usually treated by low anterior resection with en bloc removal of the vagina and uterus. However, failure can occur when one is trying to access the anterior recto-vaginal plane below the tumor, especially in obese patients with a narrow pelvis. The remaining surgical alternatives are aggressive and debilitating. The objective of the study is to describe a modified supralevator pelvic exenteration for selected patients. A new surgical option is added to the armamentarium of the oncologic surgeon. The discussion focuses on the indications for this surgical technique and its advantages, such as the preservation of the anal sphincter and the vagina, thus allowing for fecal continence and sexual activity.     

Pelvic and sacropelvic exenteration for locally advanced or recurrent anorectal cancer

Postirradiation "fixed" anorectal tumors are often considered incurable. Since 1980, we have carried out 12 pelvic and seven sacropelvic exenterations for this problem (adenocarcinoma, 18; squamous cancer, one). Nine tumors were primary; ten were recurrent (five after an anterior resection and five after an abdominoperineal resection). Prior irradiation ranged from 3000 to 12,000 rad (30 to 120 Gy). Four patients had synchronous distant metastases; three died of disease (one with local recurrence), and the fourth patient has been living with disease (distant metastasis). Fifteen patients (four with B2 tumors and 11 with Astler-Coller C2 disease) had no extrapelvic disease. One patient died of postoperative complications; two others died free of disease. Three of the 15 patients died of disease (all with local recurrence), and one has been living with disease (local recurrence). Eight (53%) of 15 patients have been living free of disease 12+ to 53+ months. The results suggest that many patients with fixed postirradiation anorectal tumors may be salvaged by aggressive surgery.     

Pelvic exenteration in advanced and or recurrent rectal cancer

Operative procedures of pelvic exenteration which were performed on a 54 yrs male patient with irradiated rectal cancer involving the prostatic gland, perineal skin and gluteal muscles were demonstrated by cinema. Perianal fistula formation and hard fibrotic adhesion between the distal rectum and the sacrum were also seen. As a result, combined resection of the perianal skin, gluteal muscles and distal sacral bone (fourth and fifth sacral and coccygeal vertebrae) was carried out. Fifty four total pelvic exenteration were performed at National Cancer Center Hospital from 1962 to 1985. The procedures were performed as a definitive treatment for the primary tumors in 35 cases (31 males and 4 females) which corresponds to 2.7% of operated primary rectal cancer at the same period and for the locally recurrent cancer in 19 cases (13 males and 6 females). By post operative histopathological examination 35 operations, 28 of 35 primary and 7 of 19 recurrent cases, were assessed as potentially curative. Hospital death rate was 13%; i.e. 7 cases (1 of 35 primary and 6 of 19 recurrent cases). Postoperative survival rates of the 54 patients were calculated by Kaplan-Meier's method. There were 17 survivors among 35 curatively operated patients and 5 yr survival rate was 34%. On the other hand, though 6 patients are surviving, there is no long term survivor (more than 35 months) among 21 patients who were treated by palliative resection.     

Pelvic exenteration for advanced colorectal cancer with reconstruction of urinary and sphincter functions

BACKGROUND: Total pelvic exenteration (TPE) for the treatment of advanced colorectal cancer usually involves a double stoma for faecal and urinary excretion, which reduces patient quality of life. In this study, a stomaless reconstruction method for patients normally requiring TPE was evaluated. METHODS: Five patients underwent stomaless TPE. After removal of the tumour with an adequate surgical margin, the urethra was transected at the urogenital diaphragm and the rectum at the anal canal. An ileal neobladder was constructed and coloanal anastomosis was performed. The major omentum was used to construct a septum between the anastomoses. A transgastric ileus tube was used as an intestinal stent to prevent ileus. RESULTS: All patients were alive 12-39 months after operation. Faecal continence was preserved in four patients whose diverting colostomies were closed. All five patients were able to void urine spontaneously, with daytime continence. All but one, in whom cancer recurred, were mobile in the community. CONCLUSION: Stomaless TPE may be considered for locally advanced colorectal cancers that invade the genitourinary organs, provided that neither the anal canal nor the urogenital diaphragm is affected.     

盆腔脏器联合切除在局部进展期直肠癌治疗中的意义

约6%~10%的原发直肠癌及50%的复发直肠癌局部病变广泛,肿瘤长时间浸润盆内脏器或组织而不发生远处转移[1],这些肿瘤被称为局部进展期直肠癌(locally ad-vanced rectal carcinoma,LARC),传统手术难以根治,放疗仅能短暂缓解疼痛。LARC未经手术切除治疗者平均生存时间为7~8个月,不     

Pelvic exenteration for advanced rectal carcinoma.

Twelve patients with advanced rectal cancer and no evidence of extrapelvic metastases underwent pelvic exenteration. The operative mortality rate was 8.3 per cent. Determinate 3 and 5 year survival rates of 54 and 37 per cent were achieved. Criteria for the selection of patients and techniques of supravesical urinary diversion are discussed.     

Pelvic exenteration for advanced pelvic malignancies.

Our experience of 76 pelvic exenterations for advanced pelvic malignancies is presented, with emphasis on the results and complications. The overall operative mortality rate of 14% is acceptable, and a five-year survival rate of 20% has been achieved. The procedure has a definite role to play in the management of advanced but otherwise localized pelvic malignancies.     

Combined treatment of advanced stages of recurrent skin cancer of the head

OBJECT: The authors investigated whether skull base resection and primary free-flap reconstruction in a single-stage surgery is oncologically effective for treating advanced stages of recurrent skin cancer (RSC) of the head. METHODS: Eighteen consecutive patients were surgically treated. Twelve of them underwent an anterolateral skull base resection, which was performed using a pterional craniotomy combined with an orbitozygomatic osteotomy. Six patients underwent a posterolateral skull base resection, which was performed using an asterional craniotomy combined with a retrolabyrinthine petrosectomy. The wide postoperative defects were covered with muscular or myocutaneous free flaps. The main factor influencing survival was the extent of the resection: patients with no or minimal residual disease showed a statistically significant longer survival time than those with consistent residual disease. Basal cell carcinoma had a better prognosis than squamous cell carcinoma. A trend toward improved survival was observed in patients classified as T4M0 with negative lymph nodes (N0), but this trend was not statistically significant. Adjuvant radiotherapy significantly influenced both survival time and the rate of local recurrence. The surgical morbidity rate was 27.8%; there were two transient cerebrospinal fluid leaks and three seventh cranial nerve injuries. Late complications included radionecrosis in one patient and skin erosion requiring a second surgery in another patient. No deaths occurred during a 30-day postoperative period. CONCLUSIONS: Advances in skull base surgery and free-flap reconstruction allowed the authors to treat patients with advanced-stage RSC of the head in a rather satisfactory manner. Only when it is impossible to achieve no or minimal residual disease should aggressive treatment be considered.     

腹腔镜全盆腔脏器切除术治疗局部晚期及复发性直肠癌的临床效果分析

目的:探讨腹腔镜下直肠癌全盆腔脏器切除术治疗局部晚期及复发性直肠癌的可行性及短期疗效.方法:回顾分析2020年7月7日至2020年11月13日采用腹腔镜下直肠癌全盆腔脏器切除术治疗的5例局部晚期及复发性直肠癌患者的临床资料.5例患者中男4例,女1例;年龄66(60-71)岁,BMI 20.3(16.4-24.2)kg/...     

达芬奇机器人MDT模式全盆腔廓清术治疗晚期宫颈癌一例

目的总结1例达芬奇机器人多学科协作(multi-disciplinary team,MDT)模式全盆腔廓清术治疗晚期宫颈癌的技术体会,探讨该医疗模式在治疗此类疾病的可行性。 方法回顾性分析2021年9月解放军总医院第七医学中心妇产医学部1例宫颈鳞状细胞癌ⅣA期患者的临床资料及诊疗过程。 结果经MDT模式及术前准备,患者接受机器人全盆腔廓清术(广泛全子宫、双附件切除+腹主动脉旁淋巴结活检+全膀胱、部分尿道、右肾及右输尿管切除+直肠前切除术),手术顺利,围手术期无严重并发症,术后随访半年,恢复良好无复发。 结论达芬奇机器人微创手术对部分有指征晚期宫颈癌患者治疗是安全、可行的,能够达到R0切除,采用MDT模式有助于此类患者获益,值得借鉴。     

Pelvic exenteration for locally advanced colorectal carcinoma.

Pelvic exenteration provided worthwhile palliation and achieved a cumulative five-year survival rate of 38.8% in 49 patients who had carcinoma of the lower colon or rectum infiltrating adjoining pelvic viscera. Survival and the disease-free period were not significantly different after total or posterior exenteration. The stage of disease was the major determinant of outcome: five-year survival rates averaged 51.8% and 28.8% for Stages II and III, respectively. Hospital mortality (26.9%) after total exenteration was chiefly due to technical mishaps, and the inclusion of many high-risk but symptomatic elderly patients. Complete clearance of locally advanced colorectal cancer by pelvic exenteration is indicated in fit patients, especially those with Stage II disease.     

Laparoscopy-assisted transvaginal total exenteration for locally advanced cervical cancer with bladder invasion after radiotherapy

When invasive cervical cancer involves the urinary bladder or rectum, exenteration can be curative treatment. However, this operation, particularly by an open approach, carries significant morbidity, both physically and psychologically. Laparoscopic surgery has been documented to be a reasonable alternative to the open counterpart for a variety of pelvic operative procedures, including such advanced procedures as laparoscopy-assisted vaginal hysterectomy, total laparoscopic hysterectomy, and laparoscopy radical hysterectomy. With improving surgical technology and increasing surgical experience, exenteration is a logical extension of current laparoscopic practice. However, it raises skepticism regarding the feasibility and justification for the complicated surgery. We herein describe our experience in a patient undergoing total exenteration assisted by laparoscopic technology for advanced recurrent cervical cancer after extensive radiotherapy. Transperitoneal laparoscopic total exenteration with ureterosigmoidstomy and end-sigmoidostomy was accomplished in 6 hours. The whole specimen was removed en bloc transvaginally. The patient tolerated the procedure well. The only complication was a wound infection 50 days postoperatively that was controlled with debridement and antibiotics. No episodes of pyelonephritis occurred. After 1 year of follow-up, the patient is free of cancer by imaging studies and lives without associated morbidity of this extensive palliative operation except the care of the sigmoid colostomy.     

Total pelvic exenteration with preoperative irradiation for advanced primary and recurrent rectal cancer.

OBJECTIVE: To study the complication rate, local recurrence rate, and survival after total pelvic exenteration for primary advanced and recurrent rectal cancer. DESIGN: Prospective study. SETTING: Tertiary referral university hospital, Norway. SUBJECTS: 25 patients who were operated on for primary advanced and 22 for recurrent rectal cancer since 1991; 42 men and 5 women, mean age 64 years (range 44-78). All had preoperative irradiation of 46-50 Gy. MAIN OUTCOME MEASURES: Incidence of major complications, and actuarial 5-year survival and local recurrence rate. RESULTS: Twenty patients had RO resection in the primary group versus seven in the recurrent group. No R2 resections were done in the primary group compared with four in the recurrent group. Half the primary cases (n = 13) had abdominoperineal resections. Hartmann's procedures were common in both groups (n = 8 in each). Postoperative mortality at 30 days was 4% (n = 2) and in-hospital 13% (n = 6). 18 patients had major complications and 12 were reoperated on. Overall 5-year actuarial survival for 43 patients without distant metastases was 28%-those with primary tumours 36%, and those with recurrent tumours 18%-similar to the figures for RO and R1 resections. Actuarial local recurrence at 5 years for primary cancers was 18% compared with 68% for recurrent cancers, again nearly identical to the figures for R0/R1 operations (p = 0.008 and p = 0.03). CONCLUSION: Some patients with advanced rectal cancer either primary or recurrent may benefit from simultaneous en-bloc cystectomy. The higher postoperative morbidity and mortality indicate the need for well-defined indications for this procedure and the necessity for thorough preoperative staging.