Long term outcome and quality of life after pelvic exenteration for recurrent endometrial and cervical cancers

Introduction: Pelvic exenteration can cure recurrent gynecological malignancies. However, treatment morbidity is over 50% in radiated pelves. We evaluated the outcome, the morbidity and the quality of life after exenteration. Methods: Patients who underwent an exenteration for recurrent cervical or endometrial cancer in our institution between 1999 and 2011 were retrieved. Survival rates were calculated according to Kaplan-Meier method and compared using the logrank test. The EORTC QLQ-C30 and QLQ-CX24 questionnaires were sent to patients alive in January 2012. Results: We identified 25 patients: 17 (68%) had cervical cancer and 8 (32%) endometrial cancer. 92% of them had received radiotherapy previously. All patients had a central pelvic recurrence, within a median time of 30 months [4 - 384] from initial treatment. Early complications requiring a re-laparotomy occurred in 9 patients (36%). Late complications included 2 (8%) fistulas, 2 (8%) occlusion and 1 (4%) ureteral stenosis. Complete resection was obtained in 92% of patients. Disease Free and Overall survival rates were better in cervical rather than in endometrial cancer (median DFS in months 17 [2 - 145] vs 9.5 [3 - 21], p = 0.064, median OS in months 20 [2 - 145] vs 13 [4 - 42], p = 0.019). 69% of patients answered the quality of life questionnaires. Mean global quality of life score was 45 on a scale of 0 - 100, none of the patients had a sexual activity. Conclusions: Morbidity of exenteration remains high and quality of life is altered. Endometrial cancer is associated with a poorer prognosis. In those patients, exenteration should be put in balance with best supportive care.

Total pelvic exenteration and a new model of diversion for giant primitive neuroectodermal tumor of prostate: A case report and review of the literature

The present study reports a rare primitive neuroectodermal tumor (PNET) of prostate.A 27-year-old male was admitted to Harbin Medical University Cancer Hospital (Harbin,China) for dysuria and dyschezia. Magnetic resonance imaging (MRI) revealed a large mass thatmay involve the bladder and rectum next to the prostate. Histopathological analysis of biopsyof prostate indicated mesenchymal origin tumor, and immunohistochemistric stainingconfirmed diagnosis of PNET of prostate. En bloc total pelvic exenteration and double barrelsigmoidostomy were performed. Double stomas in the skin incision were used for fecal andurinary diversion, respectively. Short-term outcome is satisfactory, while long-term efficacyremains to be poor. Clinical features of PNET of prostate should be paid much more attentionand radical surgery and adjuvant chemotherapy should be recommended.

Pelvic Exenteration for Recurrent and Persistent Cervical Cancer

Background： Pelvic exenteration （PE） for primary and recurrent cervical cancer has resulted in favorable survival outcomes, but there are controversies about specific prognosis factors, and up to now, there have been no published reports from China. This study aimed to share our experiences of PE, which were performed in a single institution. Methods： Frorn January 2009 to January 2016, 38 patients with recurrent or persistent cervical cancer were included in the study, and they were followed up until January 2017. Epidemiological and clinicopathological characteristics of patients were compared for survival outcornes in univariate and Cox hazard regression analysis. Results： There were thirty-one and seven patients with recurrent and persistent cervical cancer, respectively. The median age of patients was 45 years （range 29 65 years）. Total, anterior, and posterior PE consisted of 52.6%, 28.9%, and 18.4% of cases, respectively. Early and late complications occurred in 21 （55.3%） patients and 15 （39.5%） patients, respectively. Two （5.3%） patients died due to complications related to surgeries within 3 months after PE. The median overall survival （OS） and disease-free survival （DFS） were 28.5 months （range 9-96 months） and 23 rnonths （range 4.-96 months）, respectively, and 5-year OS and DFS were 48% and 40%, respectively. Cox hazard regression analysis showed that, the margin status of the incision and mesorectal lymph node status were independent risk factors liar OS and DFS. Conclusion： In our patients with rect.rrent and persistent cervical cancer, the practice of PE might achieve favorable survival outcomes. Trial Registration： ClinicalTrials.gov, NCT03291275; https：//clinicaltrials.gov/ct2/show/NCT03291275？term-NCT03291275＆rank = 1.

Feasibility and safety of minimally invasive multivisceral resection for T4b rectal cancer:A 9-year review

BACKGROUND Colorectal cancer is the third most common cancer and the second highest cause of cancer-related mortality worldwide.About 5%-10%of patients are diagnosed with locally advanced rectal cancer(LARC)on presentation.For LARC invading into other structures(i.e.T4b),multivisceral resection(MVR)and/or pelvic ex-enteration(PE)remains the only potential curative surgical treatment.MVR and/or PE is a major and complex surgery with high post-operative morbidity.Minimally invasive surgery(MIS)has been shown to improve short-term post-operative outcomes in other gastrointestinal malignancies,but there is little evi-dence on its use in MVR,especially so for robotic MVR.This is a single-center retrospective cohort study from 1st January 2015 to 31st March 2023.Inclusion criteria were patients diagnosed with cT4b rectal cancer and underwent MVR,or stage 4 disease with resectable systemic metastases.Pa-tients who underwent curative MVR for locally recurrent rectal cancer,or me-tachronous rectal cancer were also included.Exclusion criteria were patients with systemic metastases with non-resectable disease.All patients planned for elective surgery were enrolled into the standard enhanced recovery after surgery pathway with standard peri-operative management for colorectal surgery.Complex sur-gery was defined based on technical difficulty of surgery(i.e.total PE,bladder-sparing prostatectomy,pelvic lymph node dissection or need for flap creation).Our primary outcomes were the margin status,and complication rates.Cate-gorical values were described as percentages and analysed by the chi-square test.Continuous variables were expressed as median(range)and analysed by Mann-Whitney U test.Cumulative overall survival(OS)and recurrence-free survival(RFS)were analysed using Kaplan-Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.RESULTS A total of 46 patients were included in this study[open MVR(oMVR):12(26.1%),miMVR:36(73.9%)].Patients’American Society of Anesthesiologists score,body mass index and co-morbidities were comparable between oMVR and miMVR.There is an increasing trend towards robotic MVR from 2015 to 2023.MiMVR was associated with lower estimated blood loss(EBL)(median 450 vs 1200 mL,P=0.008),major morbidity(14.7%vs 50.0%,P=0.014),post-operative intra-abdominal collections(11.8%vs 50.0%,P=0.006),post-operative ileus(32.4%vs 66.7%,P=0.04)and surgical site infection(11.8%vs 50.0%,P=0.006)compared with oMVR.Length of stay was also shorter for miMVR compared with oMVR(median 10 vs 30 d,P=0.001).Oncological outcomes-R0 resection,recurrence,OS and RFS were comparable between miMVR and oMVR.There was no 30-d mortality.More patients underwent robotic compared with laparoscopic MVR for complex cases(robotic 57.1%vs laparoscopic 7.7%,P=0.004).The operating time was longer for robotic compared with laparoscopic MVR[robotic:602(400-900)min,laparoscopic:Median 455(275-675)min,P<0.001].Incidence of R0 resection was similar(laparoscopic:84.6%vs robotic:76.2%,P=0.555).Overall complication rates,major morbidity rates and 30-d readmission rates were similar between la-paroscopic and robotic MVR.Interestingly,3-year OS(robotic 83.1%vs 58.6%,P=0.008)and RFS(robotic 72.9%vs 34.3%,P=0.002)was superior for robotic compared with laparoscopic MVR.CONCLUSION MiMVR had lower post-operative complications compared to oMVR.Robotic MVR was also safe,with acceptable post-operative complication rates.Prospective studies should be conducted to compare short-term and long-term outcomes between robotic vs laparoscopic MVR.

Robotic surgery for multi-visceral resection in locally advanced colorectal cancer:Techniques,benefits and future directions

Colorectal cancer accounts for 10%of diagnosed cancers globally and often presents as advanced disease,necessitating aggressive treatment.With both younger and healthier elderly patients being diagnosed,as well as potentially the need for salvage therapy post total neoadjuvant treatment,surgical options for cure include pelvic exenteration.Whilst typically performed via an open approach,there has been an increased utilisation of minimally invasive techniques including robotic surgery.Offering smaller in-cisions,reduced postoperative pain,and quicker recovery time than open surgery,robotic techniques have demonstrated lower blood loss,shorter hospital stays,and reduced morbidity.Moreover,the er-gonomic design of robotic systems provides surgeons with comfort during long procedures and increased precision.It also offers an increased opportunity for organ preservation and reconstruction whilst maintaining adequate oncological outcomes.As robotic technology continues to evolve and combines with artificial intelligence,it is poised to play an even more significant role in the management of complex colorectal cancer cases,improving survival and long-term outcomes.