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Background: Pelvic exenteration is a procedure with high morbidity despite careful patient selection. This study investigates potential associations between perioperative markers and major postoperative complications including survival. Methods: Retrospectively collected data for 195 consecutive patients who underwent total pelvic exenteration (January 2015–February 2020) at a single tertiary university hospital were analyzed. Results: The 30-day mortality was 0.5%, and the rate of major postoperative complications (≥3 Clavien-Dindo) was 34.5%. Low albumin level (p = 0.02) and blood transfusion (p = 0.02) were significantly correlated with a major postoperative complication in univariate analyses. This had no impact on survival. Positive margins (p = 0.003), liver metastasis (p = 0.001) were related to poor survival in multivariate analyses for colorectal patients. A Charlson Comorbidity Index >6 (p < 0.05) was associated with poor survival in all patients. Conclusion: The occurrence of major postoperative complication does not negatively impact the overall survival. Pelvic exenteration is a potential life-prolonging operation when negative margins can be obtained, despite known risks for complications. Comorbidity is a predictor for inferior outcomes.

Summary: Background: The rectus abdominis myocutaneous flap has been used as the first choice for pelvic and perineal reconstruction. However, due to previous abdominal surgery and multiple stoma placements in our patients, the rectus abdominis myocutaneous flap could not be used for such reconstruction. Here, we describe the use of bilateral gluteal fold flaps for pelvic and perineal reconstruction following total pelvic exenteration to treat recurrent cervical cancer. Methods: We performed three bilateral gluteal fold flap operations for perineal reconstruction in three patients between 2008 and 2011. The cause of the perineal defect was total pelvic exenteration, which was performed to treat recurrent cervical cancer in all patients. Results: All flaps completely survived and there were no severe postoperative complication. Good cosmetic results were achieved in all patients. Conclusions: The gluteal fold flap is a useful option for reconstructing extensive pelvic and perial defect after total pelvic exenteration because of sufficient soft tissue volume, reliable blood supply, cosmetic results and minimal donor-site morbidity. Keywords: Gluteal fold flap, Total pelvic exenteration, Pelvic reconstruction, Perineal reconstruction

ResumenObjetivoEl objetivo de este estudio es mostrar los resultados inmediatos y alejados de la exenteración pélvica total (EPT) en el manejo de tumores primarios de recto localmente avanzados. Se describe una alternativa técnica en los casos de EPT supraelevador. La EPT puede ser la única oportunidad de curación en pacientes con tumores pélvicos de gran volumen.Material y métodoSe incluyen tumores T4 por la estadificación clínica o los hallazgos operatorios sometidos a una EPT con intención curativa.ResultadosEn un periodo de 16años se intervienen con esta técnica 10 pacientes, 6 de los cuales recibieron radioquimioterapia neoadyuvante. La técnica clásica se empleó en 3 pacientes y la EPT supraelevador, en 6. El promedio de hospitalización fue de 36días (rango, 18-97) y la morbilidad alcanzó el 80%. El estudio de la pieza operatoria confirmó un tumor T4 en 6 pacientes, T3 en 3 y T0 en uno. Los 6 pacientes con neoadyuvancia son 1 ypT0N0M0, 2 ypIIA, 2 ypIIC y 1 ypIIIB. El resto eran 2 pIIC y 2 pIIIC. En el seguimiento hay 5 pacientes vivos entre 30 y 180meses, y 3 fallecen por metástasis a distancia sin recidiva local.ConclusiónLa EPT es una intervención asociada a una elevada morbilidad y larga estadía hospitalaria. La EPT supraelevador protegida mediante una ileostomía transitoria evitó una colostomía definitiva en 6 de 10 casos. La ileostomía urinaria muestra resultados funcionales satisfactorios en el largo plazo. La sobrevida prolongada en la mitad de los pacientes justifica la indicación de la técnica en casos seleccionados.AbstractAimTo report the results of total pelvic exenteration (TPE) in patients with locally advanced primary rectal tumors.Material and methodWe report 10 patients with stage 4 rectal tumors subjected to a potentially curative TPE in a period of 16years.ResultsSix patients received also adjuvant chemoradiotherapy. A classic technique was used in 3 patients and a supra-elevator technique in 6. Mean hospitalization length was 36 days, and 80% of patients had complications. The pathological study of the surgical piece confirmed a T4 tumor in 6 patients, T3 in 3 and T0 in one. Among patients who received chemoradiotherapy, one was in stage ypT0N0M0, 2 in ypIIA, 2 in ypIIC, one in ypIIIB, 2 in pIIC and 2 in pIIIC. During follow up 3 patients survived between 30 and 180months and three died due to distant metastases without local relapse.ConclusionTPE requires long hospital stays and has a high rate of complications. Supra-elevator TPE protected with a transitory ileostomy avoided definitive colostomy in 6 of 10 cases. Urinary ileostomy had satisfactory long term functional results. The prolonged survival of half of the patients justifies the use of this surgical technique

The objective is to investigate preoperative body mass index (BMI) in patients receiving beyond total mesorectal excision (bTME) surgery. The primary end point is length of postoperative stay. Secondary end points are length of intensive care stay, postoperative morbidity and overall survival. BMI is the most commonly used anthropometric measurement of nutrition and studies have shown that overweight and obese patients can have improved surgical outcomes. Patients who underwent a bTME operation for locally advanced or recurrent rectal cancer were put into three BMI (kg/m2) groups of normal weight (18.5–24.9), overweight (25–29.9) and obese (≥ 30) for analysis. Included are 220 consecutive patients from a single centre. The overall length of stay, in days ± standard deviation (range), for normal weight, overweight and obese patients was 21.14 ± 16.4 (6–99), 15.24 ± 4.3 (7–32) and 19.10 ± 9.8 (8–62) respectively (p = 0.002). The mean ICU length of stay was 5.40 ± 9.1 (1–69), 3.37 ± 2.4 (0–19) and 3.60 ± 2.4 (1–14), respectively (p = 0.030). There was no significant difference between the three groups in terms of postoperative morbidity or overall survival. Patients with a normal weight BMI in this cohort have a significantly longer length of stay in ICU and in hospital than overweight or obese patients. This is seen with no significant difference in morbidity or overall survival.

Rationale: Pelvic exenteration is considered a method to treat central recurrent or persistent gynecologic malignancy after the initial therapy. The postoperative survival rate has been greatly increased by the improvement in the surgical technology and the perioperative management. Yet various complications are still impacting the quality of life. New technologies such as robotic surgery system made it possible to approach radical surgical resection by using a minimally invasive method. Patient concerns: The patient is a 53-year-old female with the cervical adenocarcinoma pelvic recurrence who had undergone the adjuvant chemo-radiotherapy and the laparoscopic radical hysterectomy in our hospital 2 years ago. She still expected her life to be prolonged through surgery therapy. Diagnoses: Locoregional recurrence of cervical adenocarcinoma. Interventions: A robotic total pelvic exenteration with ileal neobladder was performed. Outcomes: The postoperative results were excellent and after 17-month follow-up, the patient is alive and satisfied without any recurrence or distant metastasis. Lessons: For the patients with advanced or recurrent cervical cancer who are willing to receive surgical therapy and not sensitive to chemo-radiotherapy, robotic-assisted laparoscopic total pelvic exenteration is technically a feasible surgical method for recurrent pelvic malignancies. Yet the operation time should be further controlled to reduce complications which include pressure sore and thrombus. Moreover, appropriate assessment is required in the selection of the methods for reconstruction.

Total pelvic exenteration for locally recurrent rectal cancer typically requires extensive excision of the pelvic floor with perineal skin. Due to the extensiveness of the procedure and its non-curative nature, it is controversial as purely palliative therapy. A 66-year-old male patient who had undergone abdominoperineal resection at another hospital 8 years prior was admitted to our hospital. During radiation and chemotherapy for 2 years, he complained of perineal pain, discharge, cacosmia and bleeding from a recurrent tumor. The 10 × 8 cm recurrent tumor was exposed on the perineum and the patient suffered from serious discomfort in his daily life during walking or sitting. We performed total pelvic exenteration with partial sacrectomy, after which the large perineal defect was reconstructed with a bilateral V-Y gluteus maximus advancement flap in approximately 120 min. The patient's postoperative course was satisfactory and his quality of life markedly improved.

Aim There is wide disparity in the care of patients with multi-visceral involvement of rectal cancer. The results of treatment of advanced and recurrent colorectal cancer are presented from a centre where a dedicated Multidisciplinary Team (MDT) is central to the management. Method All consecutive MDT referrals between 2010 and 2014 were examined. Analysis was undertaken of the referral pathway, site, selection process, management decision, R0 resection rate, mortality / morbidity / Clavien-Dindo (CD) classification of morbidity, length of stay (LOS), and improvement of quality of life. Results There were 954 referrals. These included locally advanced primary rectal cancer (LAPRC b-TME) [39.0%], rectal recurrence (RR) [22.0%], locally advanced primary colon cancer (LAPCC T3c/d-T4) [21.1%], colon cancer recurrence (CR) 12.4%, locally advanced primary anal cancer (LAPAC-failure of CRT/ T3c/d-T4) [3.0%] and anal cancer recurrence (AR) [2.2%]. Among these patients 271 operations were performed, 212 primary and 59 for recurrence. These included 16 sacrectomies, 134 total pelvic exenterations) and 121 other multi-visceral exenterative procedures. An R0 resection (no microscopic margin involvement) was achieved in 94.4% and R1 (microscopic margin involvement) in 5.1%. In LAPRC b-TME the R0 rate was 96.1% and for RR it was 79%. The length of stay (LOS) varied from 13.3-19.9 days. RR operations had the highest morbidity (Clavien–Dindo [CD] 1-2 33.3%) and LAPRC operations had the highest rate of CD 3-4 complications (18.4%). Most (39.6%) of the referred patients were from other UK hospitals Conclusion Advanced colorectal cancer can be successfully treated in a dedicated referral centre, achieving R0 resection in over 90% with low morbidity and mortality. Implementation of a standardised referral pathway is encouraged. This article is protected by copyright. All rights reserved.

Background Previous reports about laparoscopic total pelvic exenteration (LTPE) are still limited. In the present study, we described our single-center experience of the initial 11 cases. Methods Between April 2011 and September 2015, eight males and three females diagnosed as pelvic malignancies underwent LTPE by the same operation team. We retrospectively collected all cases’ parameters about surgical technique. Thirty-seven patients who received open surgery were also retrospectively collected. A comparison between LTPE and open surgery was performed to evaluate the feasibility and safety of LTPE. Results Eleven cases successfully underwent the LTPE without any intraoperative complication. No open conversion was required. Eight patients underwent Bricker’s procedure. Three patients were performed with the cutaneous ureterostomy. Anus preservation operation was performed in three patients. Compared with open surgery, LTPE had longer mean operative time (565.2 vs 468.2 min, p = 0.004) but less mean blood loss (547.3 vs 1033.0 ml, p

Exponemos un caso clínico con el objetivo de mostrar como puede presentarse un cuadro de hipertermia con consecuencias hemodinámicas graves, así como destacar que un diagnóstico (clínico y mediante sistemas de monitorización mínimamente invasivos) y tratamiento precoces son imprescindibles para conseguir una adecuada evolución del paciente. Es un caso de hipertermia iatrogénica en un hombre de 59 años sometido a exenteración pélvica total. Mostramos cómo la hipertermia puede presentarse con repercusión clínica importante y grave, en forma de Síndrome de Respuesta Inflamatoria Sistémica, que puede poner en peligro la vida del paciente, y como su diagnóstico y tratamiento precoz (mediante la monitorización con el sistema VIGILEO) puede ser clave para que la evolución del cuadro sea adecuada. La conclusión a la cual queremos llegar es que la hipertermia puede presentarse como un SRIS y que la monitorización hemodinámica y de la temperatura corporal puede ayudarnos en su diagnóstico y tratamiento., We report a case in order to show how you can present with symptoms of hyperthermia with severe hemodynamic consequences and noted that a diagnosis (clinically and by systems of minimally invasive monitoring) and early treatment are essential for adequate patient outcome. It’s a case of iatrogenic hyperthermia in a man of 59 years underwent total pelvic exenteration. We show how hyperthermia can present with significant and serious clinical consequences, as syndrome systemic inflammatory response, which may endanger the patient’s life, as early diagnosis and treatment (by monitoring the Vigileo system) can be key to the evolution of the condition is appropriate. The conclusion at which we arrive is that hyperthermia may occur as a SIRS and hemodynamic and body temperature monitoring may help in diagnosis and treatment.