Division of Colorectal Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Int J Colorectal Dis. 2019 Jun;34(6):1043-1046. doi: 10.1007/s00384-019-03280-8. Epub 2019 Apr 5.
Our study seeks to describe our surgical technique of the use of a tissue expander and a pelvic sling in order to perform high-dose pelvic irradiation without incurring radiation toxicity to the small bowel. High-dose radiation therapy for pelvic tumours comes at a risk of radiation toxicity to the small bowel. Our study discusses our novel surgical technique of compartmentalising the abdomen and the pelvis through the use of a tissue expander and pelvic sling to avoid small bowel radiation toxicity.
We present a patient with an unresectable sacral chordoma. We describe our surgical technique incorporating both a tissue expander and an absorbable pelvic mesh sling to successfully compartmentalise the abdomen from the pelvis.
The patient underwent an uneventful surgical procedure to place the tissue expander within the pelvis and deploy the pelvic mesh sling. Following surgery, a separation of at least 8 cm was achieved between bowel loops and the tumour. A dose of 70 Gy delivered over 35 fractions using intensity modulated radiotherapy (IMRT) was administered to the sacral chordoma, whilst managing to constrain the maximum bowel dose to 35.7 Gy. Surgery to remove the tissue expander was uneventful. The patient has not suffered any small bowel irradiation toxicity.
Our technique to exclude small bowel from the pelvis is effective and safe. This technique not only can be applied in the setting of unresectable sacral chordomas but also may be applicable to other pelvic cancers which require radiation therapy.
本研究旨在描述我们使用组织扩张器和骨盆吊带的手术技术，以便在不引起小肠放射性毒性的情况下进行高剂量盆腔照射。盆腔肿瘤的高剂量放射治疗有引起小肠放射性毒性的风险。本研究讨论了我们通过使用组织扩张器和骨盆吊带将腹部和骨盆分隔开的新手术技术，以避免小肠放射性毒性。
我们介绍了一位患有不可切除的骶骨脊索瘤的患者。我们描述了我们的手术技术，包括使用组织扩张器和可吸收的骨盆网兜吊带，成功地将腹部和骨盆分隔开。
患者顺利进行了手术，将组织扩张器放置在骨盆内，并展开骨盆网兜吊带。手术后，肠袢和肿瘤之间至少有 8 厘米的分离。采用调强放疗（IMRT）给予骶骨脊索瘤 70Gy 的剂量，同时将最大肠道剂量限制在 35.7Gy。取出组织扩张器的手术也很顺利。患者没有出现任何小肠放射性毒性。
我们将小肠从骨盆中排除的技术是有效和安全的。这种技术不仅可以应用于不可切除的骶骨脊索瘤，也可能适用于其他需要放射治疗的盆腔癌症。
