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This study was designed with an aim to share our experience of primary pelvic exenterations. The study included 23 patients with different types of pelvic cancer enrolled at a single institution between November 2011 and July 2020. The patient mean age was 55 years (range, 43-72 years) and the oncological indications included: Stage IVa cervical cancer (11 cases, 48.9%), stage IVa endometrial cancer (1 case, 4.3%), stage IVa vaginal cancer (6 cases, 26%), stage IIIb bladder cancer (3 cases, 13%), stage IIIc rectal cancer (1 case, 4.3%) and undifferentiated pelvic sarcoma (1 case, 4.3%). Total, anterior, and posterior pelvic exenterations were performed on 34.4, 56.5 and 13% of cases, respectively. Related to levator ani muscle, 13 (56.5%) pelvic exenterations were supralevatorian, 10 (43.5%) infralevatorian, and 5 (21.7%) were infralevatorian with vulvectomy. No major intraoperative complications occurred. Seven patients (30.5%) developed early complications, 4 of them (17.4%) required reoperation and 1 (4.3%) perioperative death caused by a pulmonary embolism was recorded. Only 1 patient experienced a late complication, a urostomy stenosis. Over a median follow-up period of 35 months, 8 (34.8%) patients died. The median overall survival (OS) was 33 months (range, 1-96 months). The 2-year and 5-year survival rates were 72 and 66%, respectively. Primary pelvic exenteration may be related with various postoperative complications, without high perioperative morality and with long-term survival.

The aim of this study was to present our experience of 18 cases of abdominal radical trachelectomy (ART), including 5 performed during pregnancy, analyzing patient selection, surgical complications, and oncological and obstetrical outcomes. This reproductive study included all early stage cervical cancer patients referred for ART at the 1st Obstetrics and Gynecology Clinic of the Emergency Clinical County Hospital Targu Mures, between 2010 and 2020. A total of 19 women were considered for ART, and only 1 case required conversion to radical hysterectomy. The patient mean age was 31 years (range 24-38 years), and 66.67% of the patients were nulliparous. Six women (33.33%) had stage IA2, 4 (22.22%) had stage IB1, 5 (27.78%) had stage IB2, and 4 (22.22%) had stage IB3 disease. One intraoperative complication occurred in this series, which consisted in both right ureteral and bladder injuries. Early postoperative complications were represented by urinary bladder dysfunction (33.33%), symptomatic pelvic lymphocele (11.1%), peritonitis (5.5%), and wound infection (5.5%). Late postoperative complications included cervical stenosis (5.5%), amenorrhea (11.1%), and pelvic abscess (5.5%). Four out of the 18 patients were operated on during pregnancy between 14 and 20 weeks; 2 of them gave birth at term, 2 of them aborted shortly after the surgery. Two vaginal recurrences were recorded; both were managed by hysterectomy, partial colpectomy and adjuvant chemoradiotherapy. At this moment, all patients are alive with no evidence of disease and 3 of them managed to conceive. In conclusion, ART should be recommended as a fertility-preserving procedure for women in their reproductive age. In selected cases, ART can be performed during pregnancy with encouraging results.

Background: Pelvic exenteration can be performed in selected patients with large pelvic malignancies as a primary treatment with curative intention. This study aimed to share our experience of primary pelvic exenterations, which were performed in a single institution between November 2011 and July 2020, enroling 23 patients with different types of pelvic cancers.Results: The patients mean age was 55 years (range: 43-72 years) and the oncological indications were: stage IVa cervical cancer (11 cases, 48.9%), stage IVa endometrial cancer (1 case, 4.3 %), stage IVa vaginal cancer (6 cases, 26%), stage IIIb bladder cancer (3 cases, 13%), stage IIIc rectal cancer (1 case, 4.3%) and undifferentiated pelvic sarcoma (1 case, 4.3%). Total, anterior, and posterior pelvic exenterations have consisted of 34.4%, 56.5% and 13% of cases, respectively. Related to levator ani muscle, 13 (56.5%) pelvic exenterations were supralevatorian, 10(43.5%) infralevatorian, and 5 (21.7%) were infralevatorian with vulvectomy. No major intraoperative complications have occured. Seven patients (30.5%) have developed early complications, and 4 of them (17.4%) have required reoperation. One (4.3 %) perioperative death caused by a pulmonary embolism was recorded and one patient had a late complication represented by a urostomy stenosis. Over a median follow-up period of 35 months, 8 (34.8%) patients have died. The median overall survival (OS) was 33 months (range 1-96 months). The 2-year and 5-year survival rates were 72% and 66% respectively. Univariate analysis showed that margin status was the only factor significantly associated with disease-free survival (DFS) (p=0.016). Conclusion: Primary pelvic exenteration can be related with various postoperative complications, without high perioperative morality and with long-term survival.

(1) Background: Cervical cancer is the most common type of cancer encountered during pregnancy, with a frequency of 0.8&ndash, 1.5 cases per 10,000 births. It is a dire condition endangering patients&rsquo, lives and pregnancy outcomes, and jeopardizing their fertility. However, there is a lack of current evidence and consensus regarding a standard surgical technique for pregnant patients who suffer from this condition during pregnancy. The study aims to comprehensively update all published data, evaluating the obstetrical and oncological results of pregnant patients who underwent abdominal radical trachelectomy during early stages of cervical cancer. (2) Methods: A literature search on the Medline, PubMed, and Google Scholar databases was performed, including all articles in question up to July 2020. This study presents an overview of the literature and our institutional experience. (3) Results: A total of 25 cases of abdominal radical trachelectomy were performed during pregnancy for early cervical cancer, including the five cases managed by the authors. Of these, 81% (19 patients) gave birth to live newborns through elective C-section, and 19% (6 patients) experienced miscarriage shortly after the procedure. None of the 25 patients (100%) reported disease recurrence. (4) Conclusions: The results of the current study were satisfactory. However, abdominal radical trachelectomy does not represent the current standard of care for cervical cancer during pregnancy, but it could play an important role if more evidence on its effectiveness will be provided.

After total or anterior pelvic exenteration, a urinary diversion must be performed. The Bricker conduit, a non-continent urinary diversion tailored from the ileum, sigmoid colon, or other bowel parts, is most frequently used in gynecologic oncology surgery because of its simplicity and reliability

Despite the available effective screening techniques, cervical cancer is the most common genital malignancy in Romania. In patients with isolated pelvic recurrence after radiotherapy, exenteration represents the only chance for curative treatment. We present the case of a 45-year-old patient with a massive pelvic tumour causing intensive, poorly controlled vaginal bleeding, bilateral hydronephrosis and chronic renal failure. She underwent total infralevatorian exenteration with vulvectomy. Postoperative recovery was uneventful, and she presented a good evolution in the two months following surgery. We consider pelvic exenteration as the last treatment option to cure irradiated pelvic tumour recurrences.

A nuclear reactor of the air-cooled, graphite moderated type is described. The active core consists of a cubicle mass of graphite, approximately 25 feet in each dimension, having horizontal channels of square cross section extending between two of the opposite faces, a plurality of cylindrical uranium slugs disposed in end to end abutting relationship within said channels providing a space in the channels through which air may be circulated, and a cadmium control rod extending within a channel provided in the moderator. Suitable shielding is provlded around the core, as are also provided a fuel element loading and discharge means, and a means to circulate air through the coolant channels through the fuel charels to cool the reactor.