Modified posterior pelvic exenteration for ovarian cancer.
| Autor: | Houvenaeghel G; Service de Chirurgie Oncologique 2, Institut Paoli-Calmettes, Marseille, France. houvenag@marseille.fnclcc.fr, Gutowski M, Buttarelli M, Cuisenier J, Narducci F, Dalle C, Ferron G, Morice P, Meeus P, Stockle E, Bannier M, Lambaudie E, Rouanet P, Fraisse J, Leblanc E, Dauplat J, Querleu D, Martel P, Castaigne D |
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| Jazyk: | angličtina |
| Zdroj: | International journal of gynecological cancer : official journal of the International Gynecological Cancer Society [Int J Gynecol Cancer] 2009 Jul; Vol. 19 (5), pp. 968-73. |
| DOI: | 10.1111/IGC.0b013e3181a7f38b |
| Abstrakt: | Introduction: A modified posterior pelvic exenteration (MPE) might be needed to reach an optimal tumoral reduction. The issue of this study is to relate a multicentric experience of this kind of resection. Materials: Three hundred five patients who needed an MPE were analyzed from 9 French cancer centers. One hundred sixty-eight MPEs were performed during initial surgery (55.1%), 69 during interval surgery (22.6%), 36 after chemotherapy (11.8%), and 32 for recurrences (10.5%). Results: Three hundred two colorectal anastomoses were realized with a protective stoma in 59 (19.5%) of cases and a stoma closure in 76.5% (51). The rate of functional anastomosis was 96% (290/302). Complications occurred in 26.9% (82/305) of the patients, with a fistula in 25 (8.2%). The reintervention rate was 8.8% (27/305). The median length of hospitalization was 15 days. The absence of a macroscopic residual disease was obtained in 58% (173/303) of cases. A residual disease that was 1 cm or smaller was observed in 73 cases (24%) and 2 cm or smaller observed in 36 (11.9%). Postoperative chemotherapy was started with a median time of 32 days.Postoperative death occurred in 1 patient (0.33%). The survival rates were 62.7% and 27.6% at 2 and 5 years, respectively. With a multivariate analysis, the 2 significant prognostic factors were residual disease and time of surgery (P < 0.0001). Conclusions: A rectal invasion should not be an obstacle to reach the aim to obtain a macroscopic minimal residual disease or, if possible, the absence of one. An MPE is useful in those cases to reach optimal cytoreduction, with comparable results whatever the patient's age is. A temporary protective stoma should be considered only exceptionally. |
| Databáze: | MEDLINE |
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