Henao Ardila Julian, Sabia Domenico, Bosch Ramirez Marina, Tur Martinez Jaume, Gonzalez Moreno Santiago, Gushchin Vadim, Dellinger Thanh, Bijelic Lana
Peritoneal Surface Malignacies Unit, CHU Moises Broggi, Barcelona, Spain.
Surgical Oncology, MD Anderson Cancer Center Madrid, Madrid, Spain.
Ann Surg Oncol. 2025 Jan;32(1):324. doi: 10.1245/s10434-024-16327-0. Epub 2024 Oct 10.
Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy has become standard for resectable peritoneal surface malignancies. CRS aims to achieve complete resection of macroscopic disease through peritonectomy procedures and visceral resections. The pelvis is very frequently involved in peritoneal malignancies, making surgical techniques that ensure complete tumor removal an essential part of CRS. This is best achieved through an en bloc pelvic peritonectomy, which frequently includes a hysterectomy and bilateral oophorectomy in women.
We created a video to review technical steps and exposure tips to achieve a complete cytoreduction of the pelvis in female patients with en bloc resection of the entire pelvic peritoneum, including the cul-de-sac, the uterus, and the adnexa, with ('classic pelvic peritonectomy') or without ('visceral-sparing pelvic peritonectomy') rectosigmoid resection. The creation of a protective ileostomy in classic pelvic peritonectomy is routine in many centers, while other centers advocate only selective and sparing use of ileostomy. In our center, protective ileostomy is used selectively and is therefore not included in the video.
In the first part of the video, we review the rationale, indications, and steps, while in the second part, we show a practical demonstration of both a classic and a visceral-sparing pelvic peritonectomy in female patients.
Complete pelvic peritonectomy can be achieved both with or without en bloc resection of the rectosigmoid colon. This technique is an essential part of CRS, and mastery of the technique can help the likelihood of achieving complete tumor removal in advanced or complex involvement of the pelvis.
细胞减灭术（CRS）联合或不联合腹腔热灌注化疗已成为可切除腹膜表面恶性肿瘤的标准治疗方法。CRS旨在通过腹膜切除术和脏器切除术实现肉眼可见病灶的完全切除。骨盆在腹膜恶性肿瘤中常受累，因此确保肿瘤完全切除的手术技术是CRS的重要组成部分。这最好通过整块盆腔腹膜切除术来实现，在女性患者中通常包括子宫切除术和双侧卵巢切除术。
我们制作了一个视频，回顾了技术步骤和暴露技巧，以实现对女性患者进行整块切除整个盆腔腹膜（包括直肠子宫陷凹、子宫和附件）的情况下，对骨盆进行完全细胞减灭，包括（“经典盆腔腹膜切除术”）或不包括（“保留脏器的盆腔腹膜切除术”）直肠乙状结肠切除术。在许多中心，经典盆腔腹膜切除术中常规进行保护性回肠造口术，而其他中心则主张仅选择性和谨慎地使用回肠造口术。在我们中心，保护性回肠造口术是选择性使用的，因此未包含在视频中。
在视频的第一部分，我们回顾了原理、适应症和步骤，而在第二部分，我们展示了女性患者经典盆腔腹膜切除术和保留脏器的盆腔腹膜切除术的实际操作演示。
无论是否整块切除直肠乙状结肠，都可以实现完全盆腔腹膜切除术。该技术是CRS的重要组成部分，掌握该技术有助于提高在骨盆晚期或复杂受累情况下实现肿瘤完全切除的可能性。
