Höckel Michael
Department of Obstetrics and Gynecology, Women's and Children's Center, University of Leipzig, Leipzig, Germany.
Gynecol Oncol. 2008 Nov;111(2 Suppl):S13-7. doi: 10.1016/j.ygyno.2008.07.022. Epub 2008 Aug 23.
Exenteration has been used for the last 6 decades, mainly to treat cancers of the lower and middle female genital tract in the irradiated pelvis. New ablative techniques based on developmentally derived surgical anatomy termed laterally extended endopelvic resection (LEER) aim to increase the curative resection rate, even of tumors extending to and fixed to the pelvic side wall. LEER is performed as a combination of at least two of the following procedures: total mesorectal excision, total mesometrial resection, and total mesovesical resection. In cases of lateral tumor fixation, the inclusion of pelvic side wall and floor muscles, such as the obturator internus muscle and pubococcygeus, iliococcygeus and coccygeus muscles, and eventually of the internal iliac vessel system assures the completeness of the multicompartmental resection. One hundred patients with locally advanced (n=25) and recurrent (n=75) gynecologic tumors have been treated with these new procedures. In 76 patients, the tumors were fixed to the pelvic side wall. Two patients with advanced age and extensive comorbidity died during the early postoperative period. Moderate and severe treatment-related morbidity was 70%, mainly due to compromised healing of irradiated tissue and the performance of complex reconstructions. At a median follow-up period of 30 months (range, 1-136 months), 5-year recurrence-free and disease-specific overall survival probabilities are 62% (95% CI, 52-72%) and 55% (95% CI, 43-67%), respectively. LEER has significant potential to salvage selected patients with locally advanced and recurrent gynecologic malignancies, including those with pelvic side wall disease, traditionally not considered for surgical therapy.
过去60年来一直采用盆腔脏器清除术,主要用于治疗放疗后的盆腔中、下女性生殖道癌症。基于发育衍生的手术解剖学发展而来的新消融技术,即侧向扩大盆腔内切除术(LEER),旨在提高根治性切除率,即使是对于已扩展并固定于盆腔侧壁的肿瘤。LEER通过以下至少两种手术联合进行:直肠系膜全切除术、子宫系膜全切除术和膀胱系膜全切除术。对于肿瘤侧向固定的病例,纳入盆腔侧壁和盆底肌肉,如闭孔内肌、耻骨尾骨肌、髂尾骨肌和尾骨肌,最终纳入髂内血管系统,可确保多腔室切除的完整性。100例局部晚期(n = 25)和复发性(n = 75)妇科肿瘤患者接受了这些新手术治疗。76例患者的肿瘤固定于盆腔侧壁。2例高龄且合并症广泛的患者在术后早期死亡。中度和重度治疗相关并发症发生率为70%,主要原因是放疗组织愈合受损以及进行了复杂的重建手术。中位随访期为30个月(范围1 - 136个月),5年无复发生存率和疾病特异性总生存率分别为62%(95%CI,52 - 72%)和55%(95%CI,43 - 67%)。LEER有显著潜力挽救部分局部晚期和复发性妇科恶性肿瘤患者,包括那些传统上不考虑手术治疗的盆腔侧壁疾病患者。