Tatar Burak, Yalçın Yakup, Erdemoğlu Evrim
University of Health Sciences, Samsun Training and Research Hospital, Clinic of Gynecologic Oncology, Samsun, Turkey.
Isparta State Hospital, Clinic of Gynecologic Oncology, Isparta, Turkey.
Turk J Obstet Gynecol. 2019 Mar;16(1):80-83. doi: 10.4274/tjod.galenos.2018.66743. Epub 2019 Mar 27.
Recurrent cervical cancer can cause severe morbidity. Despite the severe morbidity after surgery, pelvic exenteration is still used today for mainly curative intent. This intention is neither based on randomized controlled trials (RCTs) nor high quality non-RCTs with adequate patient numbers comparing medical management with surgery. The same is true for exenteration for palliative intent, so the patient selection for either curative or palliative intent must be considered on a patient-by-patient basis.
A 35-year-old patient who had undergone primary chemo-radiotherapy for advanced cervical cancer presented with intractable pain on the swollen left leg and pelvis 8 months later. Left lower extremity Doppler ultrasound revealed echogenic thrombus in the external iliac, femoral, and popliteal veins, consistent with acute deep vein thrombus. She underwent total exenteration, end colostomy, ileal urinary conduit, pelvic lymphadenectomy, paraortic lymph node sampling, and ilio-femoral arterial and venous bypass.
The procedure relieved her pain, the leg diameter dramatically decreased from 75 cm to 44 cm, and circulation of the leg was reestablished. The procedure deferred leg amputation for about five months.
To the best of our knowledge, this is the first report of a palliative pelvic exenteration for cervical cancer with combined iliofemoral arterial and venous bypasses. These procedures, with high morbidity and mortality, are also more controversial when undertaken for just palliation of symptoms. They must be considered in the basis of each patient, and the benefits and risks must be discussed thoroughly in a realistic perspective with the patient.
复发性宫颈癌可导致严重的发病率。尽管手术后发病率很高，但盆腔脏器切除术如今仍主要用于治疗目的。这种意图既不是基于随机对照试验（RCT），也不是基于有足够患者数量的高质量非RCT，将药物治疗与手术进行比较。姑息性盆腔脏器切除术也是如此，因此必须逐例考虑针对治疗或姑息意图的患者选择。
一名35岁的患者，曾因晚期宫颈癌接受过原发性放化疗，8个月后出现左腿和骨盆肿胀伴顽固性疼痛。左下肢多普勒超声显示髂外、股和腘静脉内有强回声血栓，符合急性深静脉血栓形成。她接受了全盆腔脏器切除术、结肠造口术、回肠代膀胱术、盆腔淋巴结清扫术、腹主动脉旁淋巴结取样以及髂股动静脉搭桥术。
该手术缓解了她的疼痛，腿部直径从75厘米大幅降至44厘米，腿部血液循环得以重建。该手术使截肢推迟了约五个月。
据我们所知，这是首例针对宫颈癌进行姑息性盆腔脏器切除术并联合髂股动静脉搭桥术的报告。这些手术发病率和死亡率高，在仅用于缓解症状时也更具争议性。必须逐例考虑，并且必须从现实角度与患者充分讨论其益处和风险。
