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Resection of pelvic side wall recurrence


Medical editor Gunnar B. Kristensen MD
Gynecological Oncologist
Oslo University Hospital

General

For recurrence localized in the pelvic wall after completed curative radiation therapy for cervical cancer, surgery may be an alternative in some cases. This surgery is extensive with significant morbidity. This procedure is therefore only carried with a curative goal.

Indications

  • At least 1 year interval from completed radiation therapy to confirmed recurrence.
  • The recurrence should be 5 cm maximum evaluated by MRI.
  • The tumor should be considered resectable based on the MRI evaluation.
  • No sign of other tumor localizations in the abdomen, lymph nodes, lungs, or liver by MRI/CT.
  • The patient must be able to tolerate such an extensive surgical procedure.

Goal

Curative treatment for recurrence in the pelvic wall after completed radiation therapy.


Equipment

Gynecological surgery tray


Preparation

  • Large bowel emptying
  • Thrombosis prophylaxis
  • Antibiotic prophylaxis

Implementation

The operation is performed in collaboration between a gynecological oncologist and surgeons specializing in this type of surgery.

A prerequisite to performing this type of operation is that the tumor can be completely resected with free margins. This requires muscle interponated between the tumor recurrence and pelvic bone. During the operation, the tumor is resected with underlying muscle. Alternatively, some of the pelvic bone must be resected.

Depending on the localization of the recurrence, it may be necessary to resect the recto-sigmoideum, bladder, cervix, and vagina. In some cases, it may be necessary to perform a total pelvic exenteration in addition to the resection of the pelvic wall.

Urostomy and colostromy are constructed when necessary. 


Follow-up

All patients have follow-up at the Radium Hospital.

Complications

  • There is a significant risk for postoperative complications, especially in the form of anastomosis break down and infection.

  • Preparation of a neovagina simultaneously with the exenteration increases the risk for complications. The routine at the Radium Hospital is therefore to avoid construction of the neovagina during the same operation.

  • There may be necrosis of the stomal mucosa.

  • There may be stenosis of the ureters may occur at the implantation in the bowel segment which serves as neobladder.

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