Kappos Elisabeth A, Wendelspiess Séverin R, Stoffel Julia, Djedovic Gabriel, Rieger Ulrich M, Bannasch Holger, Fritsche Elmar, Constantinescu Mihai, Andric Mihailo, Croner Roland S, Schmidt Volker J, Plock JanA, Schaefer Dirk J, Horch Raymund E
Klinik für Plastische, Rekonstruktive, Ästhetische und Handchirurgie, Universitätsspital Basel, Basel, Schweiz.
Medizinische Fakultät, Universität Basel, Basel, Schweiz.
Handchir Mikrochir Plast Chir. 2024 Aug;56(4):269-278. doi: 10.1055/a-2358-1479. Epub 2024 Aug 13.
The surgical-oncological treatment of pelvic and perineal malignancies is associated with a high complication rate and morbidity for patients. Modern multimodal treatment modalities, such as neoadjuvant radio-chemotherapy for anal or rectal cancer, increase the long-term survival rate while reducing the risk of local recurrence. Simultaneously, the increasing surgical radicality and higher oncological safety with wide resection margins is inevitably associated with larger and, due to radiation, more complex tissue defects in the perineal and sacral parts of the pelvic floor. Therefore, the plastic-surgical reconstruction of complex pelvic-perineal defects following oncological resection remains challenging. The reconstructive armamentarium, and thus the treatment of such defects, is broad and ranges from local, regional and muscle-based flaps to microvascular and perforator-based procedures. While the use of flaps is associated with a significant, well-documented reduction in postoperative complications compared to primary closure, there is still a lack of reliable data directly comparing the postoperative results of different reconstructive approaches. Additionaly, the current data shows that the quality of life of these patients is rarely recorded in a standardised manner. In a consensus workshop at the 44 annual meeting of the German-speaking Association for Microsurgery on the topic of "Reconstruction of oncological defects in the pelvic-perineal area", the current literature was discussed and recommendations for the reconstruction of complex defects in this area were developed. The aim of this workshop was to identify knowledge gaps and establish an expert consensus to ensure and continuously improve the quality of reconstruction in this challenging area. In addition, the importance of the "patient-reported outcome measures" in pelvic reconstruction was highlighted, and the commitment to its widespread use in the era of value-based healthcare was affirmed.
盆腔和会阴恶性肿瘤的外科肿瘤治疗会给患者带来较高的并发症发生率和发病率。现代多模式治疗方法，如用于肛管或直肠癌的新辅助放化疗，在降低局部复发风险的同时提高了长期生存率。与此同时，手术根治性的提高以及更宽切除边缘带来的更高肿瘤学安全性，不可避免地伴随着盆底会阴和骶部更大且因放疗而更复杂的组织缺损。因此，肿瘤切除后复杂盆腔会阴缺损的整形重建仍然具有挑战性。重建手段广泛，从局部、区域和基于肌肉的皮瓣到微血管和穿支皮瓣手术。虽然与一期缝合相比，皮瓣的使用与术后并发症显著减少相关，且有充分记录，但仍缺乏直接比较不同重建方法术后结果的可靠数据。此外，目前的数据表明，这些患者的生活质量很少以标准化方式记录。在德语区显微外科学会第44届年会上关于“盆腔会阴区肿瘤缺损重建”主题的共识研讨会上，讨论了当前文献并制定了该区域复杂缺损重建的建议。本次研讨会的目的是找出知识空白并达成专家共识，以确保并持续提高这一具有挑战性领域的重建质量。此外，强调了“患者报告结局指标”在盆腔重建中的重要性，并肯定了在基于价值的医疗时代广泛使用该指标的承诺。
