Background： Pelvic exenteration （PE） for primary and recurrent cervical cancer has resulted in favorable survival outcomes, but there are controversies about specific prognosis factors, and up to now, there have be...Background： Pelvic exenteration （PE） for primary and recurrent cervical cancer has resulted in favorable survival outcomes, but there are controversies about specific prognosis factors, and up to now, there have been no published reports from China. This study aimed to share our experiences of PE, which were performed in a single institution. Methods： Frorn January 2009 to January 2016, 38 patients with recurrent or persistent cervical cancer were included in the study, and they were followed up until January 2017. Epidemiological and clinicopathological characteristics of patients were compared for survival outcornes in univariate and Cox hazard regression analysis. Results： There were thirty-one and seven patients with recurrent and persistent cervical cancer, respectively. The median age of patients was 45 years （range 29 65 years）. Total, anterior, and posterior PE consisted of 52.6%, 28.9%, and 18.4% of cases, respectively. Early and late complications occurred in 21 （55.3%） patients and 15 （39.5%） patients, respectively. Two （5.3%） patients died due to complications related to surgeries within 3 months after PE. The median overall survival （OS） and disease-free survival （DFS） were 28.5 months （range 9-96 months） and 23 rnonths （range 4.-96 months）, respectively, and 5-year OS and DFS were 48% and 40%, respectively. Cox hazard regression analysis showed that, the margin status of the incision and mesorectal lymph node status were independent risk factors liar OS and DFS. Conclusion： In our patients with rect.rrent and persistent cervical cancer, the practice of PE might achieve favorable survival outcomes. Trial Registration： ClinicalTrials.gov, NCT03291275; https：//clinicaltrials.gov/ct2/show/NCT03291275？term-NCT03291275＆rank = 1.展开更多
Relatively little is known about the oncologic safety of laparoscopic surgery for advanced rectal cancer.Recently, large randomized clinical trials showed that laparoscopic surgery was not inferior to open surgery, as...Relatively little is known about the oncologic safety of laparoscopic surgery for advanced rectal cancer.Recently, large randomized clinical trials showed that laparoscopic surgery was not inferior to open surgery, as evidenced by survival and local control rates. However, patients with T4 tumors were excluded from these trials. Technological advances in the instrumentation and techniques used by laparoscopic surgery have increased the use of laparoscopic surgery for advanced rectal cancer. High-definition, illuminated, and magnified images obtained by laparoscopy may enable more precise laparoscopic surgery than open techniques, even during extended surgery for T4 or locally recurrent rectal cancer. To date, the quality of evidence regarding the usefulness of laparoscopy for extended surgery beyond total mesorectal excision has been low because most studies have been uncontrolled series, with small sample sizes, and long-term data are lacking. Nevertheless, laparoscopic extended surgery for rectal cancer, when performed by specialized laparoscopic colorectal surgeons, has been reported safe in selected patients, with significant advantages, including a clear visual field and less blood loss. This review summarizes current knowledge on laparoscopic extended surgery beyond total mesorectal excision for primary or locally recurrent rectal cancer.展开更多
Extralevator abdominoperineal excision and pelvic exenteration are mutilating operations that leave wide perineal wounds.Such large wounds are prone to infection and perineal herniation,and their closure is a major co...Extralevator abdominoperineal excision and pelvic exenteration are mutilating operations that leave wide perineal wounds.Such large wounds are prone to infection and perineal herniation,and their closure is a major concern to most surgeons.Different approaches to the perineal repair exist,varying from primary or mesh closure to myocutaneous flaps.Each technique has its own associated advantages and potential complications and the ideal approach is still debated.In the present study,we reviewed the current literature and our own local data regarding the use of biological mesh for perineal wound closure.Current evidence suggests that the use of biological mesh carries an acceptable risk of wound complications compared to primary closure and is similar to flap reconstruction.In addition,the rate of perineal hernia is lower in early follow-up,while long-term hernia occurrence appears to be similar between the different techniques.Finally,it is an easy and quick reconstruction method.Although more expensive than primary closure,the cost associated with the use of a biological mesh is at least equal,if not less,than flap reconstruction.展开更多
文摘Background： Pelvic exenteration （PE） for primary and recurrent cervical cancer has resulted in favorable survival outcomes, but there are controversies about specific prognosis factors, and up to now, there have been no published reports from China. This study aimed to share our experiences of PE, which were performed in a single institution. Methods： Frorn January 2009 to January 2016, 38 patients with recurrent or persistent cervical cancer were included in the study, and they were followed up until January 2017. Epidemiological and clinicopathological characteristics of patients were compared for survival outcornes in univariate and Cox hazard regression analysis. Results： There were thirty-one and seven patients with recurrent and persistent cervical cancer, respectively. The median age of patients was 45 years （range 29 65 years）. Total, anterior, and posterior PE consisted of 52.6%, 28.9%, and 18.4% of cases, respectively. Early and late complications occurred in 21 （55.3%） patients and 15 （39.5%） patients, respectively. Two （5.3%） patients died due to complications related to surgeries within 3 months after PE. The median overall survival （OS） and disease-free survival （DFS） were 28.5 months （range 9-96 months） and 23 rnonths （range 4.-96 months）, respectively, and 5-year OS and DFS were 48% and 40%, respectively. Cox hazard regression analysis showed that, the margin status of the incision and mesorectal lymph node status were independent risk factors liar OS and DFS. Conclusion： In our patients with rect.rrent and persistent cervical cancer, the practice of PE might achieve favorable survival outcomes. Trial Registration： ClinicalTrials.gov, NCT03291275; https：//clinicaltrials.gov/ct2/show/NCT03291275？term-NCT03291275＆rank = 1.
文摘Relatively little is known about the oncologic safety of laparoscopic surgery for advanced rectal cancer.Recently, large randomized clinical trials showed that laparoscopic surgery was not inferior to open surgery, as evidenced by survival and local control rates. However, patients with T4 tumors were excluded from these trials. Technological advances in the instrumentation and techniques used by laparoscopic surgery have increased the use of laparoscopic surgery for advanced rectal cancer. High-definition, illuminated, and magnified images obtained by laparoscopy may enable more precise laparoscopic surgery than open techniques, even during extended surgery for T4 or locally recurrent rectal cancer. To date, the quality of evidence regarding the usefulness of laparoscopy for extended surgery beyond total mesorectal excision has been low because most studies have been uncontrolled series, with small sample sizes, and long-term data are lacking. Nevertheless, laparoscopic extended surgery for rectal cancer, when performed by specialized laparoscopic colorectal surgeons, has been reported safe in selected patients, with significant advantages, including a clear visual field and less blood loss. This review summarizes current knowledge on laparoscopic extended surgery beyond total mesorectal excision for primary or locally recurrent rectal cancer.
文摘Extralevator abdominoperineal excision and pelvic exenteration are mutilating operations that leave wide perineal wounds.Such large wounds are prone to infection and perineal herniation,and their closure is a major concern to most surgeons.Different approaches to the perineal repair exist,varying from primary or mesh closure to myocutaneous flaps.Each technique has its own associated advantages and potential complications and the ideal approach is still debated.In the present study,we reviewed the current literature and our own local data regarding the use of biological mesh for perineal wound closure.Current evidence suggests that the use of biological mesh carries an acceptable risk of wound complications compared to primary closure and is similar to flap reconstruction.In addition,the rate of perineal hernia is lower in early follow-up,while long-term hernia occurrence appears to be similar between the different techniques.Finally,it is an easy and quick reconstruction method.Although more expensive than primary closure,the cost associated with the use of a biological mesh is at least equal,if not less,than flap reconstruction.
