Pelvic plastic reconstruction results after small pelvis exenteration

Date 24 November 2018
Event ESMO Asia 2018 Congress
Session Poster display - Cocktail
Topics Surgical Oncology
Gynaecological Malignancies
Presenter Mirzagoleb Tillashaykhov
Citation Annals of Oncology (2018) 29 (suppl_9): ix79-ix86. 10.1093/annonc/mdy436
Authors M.N. Tillashaykhov1, N. Zakhirova2, O.M. Ahmedov3, Y.V. Ten4, S. Djanklich5
  • 1Urology, National Cancer Research Center of Uzbekistan, 100011 - Tashkent/UZ
  • 2Gynecology, City Oncology Centre, 100011 - Tashkent/UZ
  • 3Gynecology, National Cancer Research Center of Uzbekistan, 100011 - Tashkent/UZ
  • 4Coloproctology, National Cancer Research Center of Uzbekistan, 100174 - Tashkent/UZ
  • 5Gynecologic Oncology Department, National Cancer Research Center of Uzbekistan, 100174 - Tashkent/UZ

Abstract

Background

The improvement of surgical methods on locally advanced cervical cancer with invasion into the bladder is changing criteria of «unresectablity» and «unoperablity» for the condition generally.

Methods

We performed an analysis of 28 patients with locally advanced cervical cancer simultaneously plastic of pelvis with invasion into bladder which was produced by anterior exenteration of the small pelvis by omentum. Morphologically 24 patients had squamous cell carcinoma, 4 patients had adenocarcinoma. Among them 6 were the primary, 16 patients after chemoradiotherapy and 8 after radical radiation therapy.

Results

All researched patients received anterior exenteration of the small pelvis with simultaneous plastic reconstruction of the pelvis with omentum. Indications for exenteration of the small pelvis: Recurrent bleeding from the genital tract, discharge of urine from vagina, (vesicovaginal fistulas), hematuria, chronic pain syndrome, ureterohydronephrosis with one or two sides, extremely low quality of life. The following methods of urinary diversion were made: ureterocutaneosostomy (UCS) in 11 (39.3%) patients, Brikker operation in 8 (28.6%) patients, large intestine urinary reservoir with controlled emptying (self-catheterization) in 9 (32.1%) patients, depending on the clinical situation and intraoperative finding. Technique of plasty of the pelvic floor with a large omentum: a J shaped flap of a large omentum is formed. Gastric-gland artery is not affected. The complications: In the early postoperative period, 3 patients (10.7%) had a suppuration of a postoperative wound, pyelonephritis developed in 2 patients (7.1%), difficulties in self-catheterization in 2 patients (7.1%), one (2.8%) patient developed a small intestine obstruction, which was resolved conservatively.

Conclusions

The method used to reconstruct the pelvis after exenteration of the pelvic organs, especially with the formation of a large intestine urinary reservoir with controlled evacuation is the optimal amount of surgical intervention, reducing the risk of developing complications, such as intestinal obstruction, rectal-vaginal fistula, pelvic abscess and pelvic hernia, which significantly improves the quality of life of patients.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.