Abstract
Total pelvic exenteration (TPE) is sometimes required for radical treatment of locally advanced or recurrent gynecologic cancer [1]. However, TPE with a transabdominal approach requires highly advanced techniques in the case of repeated surgery due to the effects of primary surgery and/or chemoradiotherapy, especially when a transabdominal approach is used. Recent technical advances in transanal/transperineal endoscopic surgery have proved beneficial for complicated surgery in the deep pelvis [2]. Here we introduce our surgical procedure for combined laparoscopic and transperineal endoscopic TPE (TpTPE) for pelvic recurrence of cervical cancer. A 42-year-old woman was diagnosed with vaginal stump recurrence of cervical cancer involving the rectum, bladder, and ureters following hysterectomy and pelvic lymph node dissection as primary surgery and chemotherapy/chemoradiotherapy for previous recurrences. We decided to perform TpTPE with a combined laparoscopic approach. The GelPOINT advanced access platform was fixed through a perineal skin incision around the tightly closed anus, external urethral orifice, and vagina. With sufficient pneumopelvic pressure (12 mmHg), TpTPE was performed under a good surgical view without any effect of the primary surgery. A ureterostomy and sigmoid colostomy were created and a right gracilis muscle flap was used to reconstruct the pelvic defect. The total operative time and estimated blood loss were 887 minutes and 497 mL, respectively. Histopathological examination revealed recurrent cervical cancer invading the rectum, bladder, and bilateral ureters with negative surgical margins. The postoperative course was uneventful except for paralytic ileus. The patient was discharged on postoperative day 18. TpTPE is a technically feasible and effective approach for locally advanced pelvic tumors.
Keywords: Cervical Cancer, Pelvic Exenteration, Transperineal
VIDEO CLIP
Video can be found with this article online at https://ejgo.org/src/sm/jgo-33-e16-s001.mp4.
Footnotes
Presentation: The 30th Biennial Congress of the International Society of University of Colon and Rectal Surgeons 11th–14th November, 2020. Pacifico Yokohama North, Japan.
Conflict of Interest: No potential conflict of interest relevant to this article was reported.
- Conceptualization: H.S.
- Methodology: N.H., M.Y., K.A.
- Supervision: H.S.
- Visualization: A.N.
- Writing - original draft: O.R.
- Writing - review & editing: O.R., Y.G., H.S.
References
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