Gynaeoncology Department, Royal Marsden Hospital, London, UK.
Gynaeoncology Department, St. George's Hospital, London, UK.
J Obstet Gynaecol. 2021 Nov;41(8):1252-1256. doi: 10.1080/01443615.2020.1867963. Epub 2021 Mar 1.
The objective of this study is to evaluate the role of laparoscopy in the case selection of patients for pelvic exenteration to treat recurrent cervical or endometrial cancer. Pelvic exenteration is a rare surgical procedure performed by specialised multidisciplinary surgical teams. We performed a review of 55 consecutive laparoscopies for patients being evaluated for possible exenterative surgery for recurrent cervical or endometrial cancer at a single centre in the UK with a significant exenterative surgical practice. All patients had no evidence of metastatic disease on imaging prior to the laparoscopy. Despite thorough radiological assessment laparoscopy detected peritoneal, nodal or extrapelvic metastases in 20.8% of cases. 5.6% of the patients who underwent exenterative surgery were found to have unresectable pelvic disease intraoperatively. In these cases, the extent of disease was not determined radiologically or during the initial exploratory laparotomy. In our view, laparoscopic assessment is an essential component of the pre-operative work up of patients with recurrent cervical or endometrial cancer being considered for exenterative surgery.Impact statement Pelvic exenteration is potentially curative in cases of recurrent pelvic malignancy. Case selection is essential to determine those patients without metastases and with resectable pelvic disease - this will improve patient outcomes, avoid the unnecessary morbidity of major surgery, as well as the psychological consequences of abandoned procedures. The only two previous studies, published in 1998 (Plante and Roy 1998) and 2002 (Köhler et al. 2002) have shown laparoscopic assessment to be safe and improve case selection. This study provides evidence that in the context of modern imaging modalities, including PET-CT scans, laparoscopic assessment continues to improve case selection for exenterative surgery. This study provides further evidence of the benefit of laparoscopy in the assessment of patients being considered for exenterative surgery for recurrent pelvic cancer. Routine laparoscopy improves case selection and will enhance patient experiences and outcomes.
本研究旨在评估腹腔镜在选择接受盆腔廓清术治疗复发性宫颈癌或子宫内膜癌患者中的作用。盆腔廓清术是一种由专门的多学科手术团队进行的罕见手术。我们对英国一家中心的 55 例连续腹腔镜检查进行了回顾性研究，该中心有大量的盆腔廓清术手术经验。所有患者在腹腔镜检查前影像学检查均无转移病灶。尽管进行了彻底的影像学评估，但腹腔镜检查仍在 20.8%的病例中发现了腹膜、淋巴结或盆腔外转移。5.6%接受盆腔廓清术的患者在术中发现盆腔疾病无法切除。在这些情况下，疾病的范围在影像学或初始探查性剖腹术中均未确定。在我们看来，腹腔镜评估是考虑接受盆腔廓清术的复发性宫颈癌或子宫内膜癌患者术前评估的重要组成部分。
盆腔廓清术在复发性盆腔恶性肿瘤病例中具有潜在的治愈作用。选择病例至关重要，需要确定无转移且具有可切除盆腔疾病的患者——这将改善患者的预后，避免不必要的大手术发病率，以及放弃手术的心理后果。仅有的两项既往研究（Plante 和 Roy，1998 年；Köhler 等人，2002 年）表明，腹腔镜评估是安全的，并可改善病例选择。本研究提供的证据表明，在现代影像学检查方法（包括 PET-CT 扫描）的背景下，腹腔镜评估继续改善了盆腔廓清术的病例选择。本研究进一步证明了腹腔镜在评估考虑接受复发性盆腔癌盆腔廓清术的患者中的益处。常规腹腔镜检查可改善病例选择，并将提高患者的体验和结局。
