UOC di Ginecologia Oncologica, Department of Women's and Children's Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italia.
UOC di Ginecologia Oncologica, Department of Women's and Children's Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italia
Int J Gynecol Cancer. 2019 Feb;29(2):444-445. doi: 10.1136/ijgc-2018-000094. Epub 2019 Feb 4.
This video article demonstrates an inguino-abdominal combined approach for laterally extended pelvic resection, a major surgical procedure for locally advanced primary or recurrent gynecological cancer infiltrating the pelvic sidewall, for which palliative therapy is the only alternative.1 After local institutional review board approval (protocol No CICOG 02/03/62), we made a step by step surgical video of an inguino-abdominal combined approach for laterally extended pelvic resection , defined as an en bloc resection of a pelvic tumor with pelvic sidewall structures, including the iliopsoas and/or obturator internus muscles.2 3 The patient, a 48-year-old woman, diagnosed with single pelvic platinum resistant recurrence after five lines of chemotherapy for serous ovarian cancer G3, International Federation of Gynecology and Obstetrics (FIGO) stage IIIC, BRCA wild type. The preoperative positron emission tomography/computed tomography scan detected uptake on the right side at the level of the external iliac region and obturator fossa: the tumor surrounded the right external iliac vessels by more than 50% of their circumferences, with possible involvement of the vascular wall and venous vascular compression (Tinelli's score=4).4 The tumor extended towards the obturator fossa, with possible involvement of the inguinal canal. Due to an uncertain pathological response, the size of the recurrence, and its close contiguity with the ureter and bowel, we decided to avoid radiation therapy as it could result in a ureteral or intestinal fistula. We performed a laterally extended pelvic resection, as shown step by step in the video.The procedure was conducted until complete removal of recurrence (R0). Estimated blood loss was 1000 mL and total operative time was 240 min. The patient was discharged after 15 days; we reported a urinary infection, a likely postoperative complication. The pathology report described a lymphnodal relapse of ovarian cancer (diameter=6 cm) with infiltration of surrounding tissue and in the sano margins. Six months after surgery, the patient is alive without evidence of relapse.The borders of pelvic surgical anatomy are continually extending, requiring surgeons to use a personalized approach and to continually update their anatomic knowledge. In this context, laterally extended pelvic resection could be a feasible surgical procedure, representing a salvage treatment in recurrent or persistent primary gynecological malignancies infiltrating the pelvic sidewall, when other approaches have failed. However, additional clinical trials are needed to confirm these results.3.
本视频文章演示了一种腹股沟-腹部联合入路进行横向扩展骨盆切除术，这是一种用于局部晚期原发性或复发性妇科癌症浸润骨盆侧壁的主要手术方法，对于此类患者，姑息性治疗是唯一选择。1 在获得当地机构审查委员会批准（协议号 CICOG 02/03/62）后，我们制作了一份关于腹股沟-腹部联合入路进行横向扩展骨盆切除术的分步手术视频，该手术定义为整块切除带有骨盆侧壁结构的骨盆肿瘤，包括腰大肌和/或闭孔内肌。2,3 患者为 48 岁女性，在接受五次顺铂为基础的化疗治疗浆液性卵巢癌 G3、国际妇产科联盟（FIGO）分期 IIIIC 后，诊断为单一骨盆铂类耐药复发，BRCA 野生型。术前正电子发射断层扫描/计算机断层扫描（PET/CT）扫描显示右侧髂外区和闭孔窝水平摄取增高：肿瘤环绕右侧髂外血管超过其周长的 50%，可能累及血管壁和静脉血管压迫（Tinelli 评分=4）。4 肿瘤向闭孔窝方向延伸，可能累及腹股沟管。由于病理反应不确定、复发病灶大小以及与输尿管和肠道的紧密毗邻，我们决定避免放疗，因为放疗可能导致输尿管或肠瘘。我们进行了横向扩展骨盆切除术，视频中逐步展示了该手术过程。该手术过程直至完全切除复发病灶（R0）。估计失血量为 1000 毫升，总手术时间为 240 分钟。患者在 15 天后出院，我们报告了一例尿路感染，这是一种可能的术后并发症。病理报告描述了卵巢癌的淋巴结复发（直径=6 厘米），伴有周围组织浸润和切缘无肿瘤累及。手术后 6 个月，患者无复发迹象，仍存活。骨盆外科解剖的边界在不断扩展，要求外科医生采用个性化方法，并不断更新其解剖知识。在此背景下，横向扩展骨盆切除术可能是一种可行的手术方法，是局部晚期原发性或复发性妇科恶性肿瘤浸润骨盆侧壁时的一种挽救性治疗方法，当其他方法失败时可采用这种方法。然而，还需要开展更多的临床试验来证实这些结果。3.
