Malignant Neoplasms of the Rectum
Philip H. Gordon, Santhat Nivatvongs, Lee E. Smith, Scott Thorn Barrows, Carla Gunn, Gregory Blew, David Ehlert, Craig Kiefer, Kim Martens in Neoplasms of the Colon, Rectum, and Anus, 2007
Since it was first reported in 1948, pelvic exenteration has been used in the treatment of advanced pelvic malignancy. The original procedure has been modified in an attempt to preserve urinary or fecal continence. Rodriguez-Bigas and Petrelli (565) conducted a literature review on selected series of total pelvic exenterations and modified pelvic exenterations in order to assess and discuss the different types of pelvic exenterations and the indications, contraindications, morbidity, mortality, and results of these procedures. According to the series reviewed, morbidity after pelvic exenteration ranges between 32% and 84%, postoperative mortality ranges from 0% to 14%, and five-year survival varies from 23% to 68%. These numbers indicate that total pelvic exenteration and its modifications are a complex group of surgical procedures with significant early and late postoperative morbidity and mortality. While the authors think that these findings indicate that pelvic exenteration should only be undertaken by experienced surgeons at specialized centers, they also caution that, above all, their findings indicate that the potential curability of a patient with adjacent organ involvement should not be compromised by doing less than an en bloc resection.
The rectum
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
The aim is to remove pelvic organs involved in the malignant process, and may involve a partial exenteration (posterior exenteration, including rectum and posterior vagina/ uterus) or complete (including rectum and urogenital organs) (Figure73.23). Exenteration may be necessary for advanced local disease, but more commonly for disease recurrence. It involves a large excision of the pelvic floor, leaving a sizeable perineal defect that has to be reconstructed using a plastic surgical procedure. Rectus abdominus or gluteal flaps can be used to fill the empty pelvis. Special care must be taken to suture the perineal skin accurately, and to avoid pressure necrosis by nursing the patient on alternate sides. Excision of the bladder will require the formation of an ileal conduit in addition to a colostomy.
Operative Technique for Pelvic Exenteration
P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams in Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
Pelvic exenteration always involves an abdominal approach, usually with a perineal completion phase that can be done in lithotomy or prone (see Chapter 6.12). The anterior, axial, and lateral compartments are best done through an abdominal combined with a perineal lithotomy approach. Posteriorly, resection of the sacrum from S4 down and the sacrospinous ligaments allows radical excision of posterior pelvic floor that is approached from the abdominal side and is often better visualized than prone. Involvement of S3 and above by nature of the sacroiliac joint attachment requires a prone approach unless only the anterior cortex of the midline bones of L5 and upper sacrum are necessary, which can be done abdominally. Lateral higher sacrum and full vertebral excision of S2 and S3 requires the posterior prone approach.
Psychosocial factors among patients undergoing orbital exenteration
Published in Clinical and Experimental Optometry, 2023
Neelima Balakrishnan, Sahil Agrawal, Rachna Bhargava, Veena Jain, Neelam Pushker, Rachna Meel, Mandeep S. Bajaj
The human face establishes the identity of a person in society. Its normalcy is an important factor for self-confidence, communication, developing interpersonal relationships and for overall well-being. Exenteration is a procedure that involves removal of contents of the orbit including appendages. It is mostly done in locally advanced malignancies that are not amenable to any other treatment as a life-saving procedure as seen in the present study also.3,4 There are several reports on psychosocial challenges associated with the cancer patients.5,6 Facial disfigurement related to destructive surgeries such as enucleation, evisceration and exenteration, adds on to the trauma due to associated social stigma leading to a functional, social, personal and financial setback.1,7 Though there are several reports available on the psychosocial issues in one-eyed patients, patients who underwent evisceration, enucleation, or had disfigurement due to facial trauma but the literature is scarce on the psychosocial impact and quality of life in patients who underwent exenteration.7 Furthermore, to the best of the knowledge, there is no prospective comparative study on pre-operative and post-operative changes in severity of psychosocial issues, quality of life and its difference with the patients wearing prosthesis post-exenteration.
Surgical treatment of the cancer of the optic nerve and orbit. An historical overview
Published in Acta Chirurgica Belgica, 2020
Konstantinos Laios, Konstantinos Markatos, Vassiliki S. Konofaou, Efstathia Lagiou, Marilita M. Moschos
We had to reach the third quarter of the nineteenth century when Carl Ferdinand Ritter von Arlt (1812–1887) gave the first scientific description of this procedure [3]. There were two main types of this operation; exenteration and partial resection of the anatomical structures in the orbit. The partial resection excluded those structures affected, while the exenteration concerned the formation of a perfect debridement cavity. The question was whether the eyelids should be maintained or not. This would depend on the aggressiveness and the extension of the tumor. If decided keeping them aiming for a better aesthetic result, the operation would begin with an excision of the canthus in the outermost boundary of the orbit. Overall, the membrane of periosteum was removed, while the other structures were prepared by means of the edge of a knife, the handle of the scalpel, curved scissors, a curette and the surgeon's finger itself. After surgery, total dissective plastic surgery was performed by transferring flaps in the orbit for the placement of an artificial eye [4].
Locally advanced sinonasal adenoid cystic carcinomas: endoscopic endonasal surgery-centered comprehensive treatment provides benefits
Published in Acta Oto-Laryngologica, 2023
Jin Wang, Meng Zhang, Wenqi Yi, Liang Li, Liangyu Li, Chuan Pang, Lei Chen
Orbital invasion is a typical pattern of locally advanced SNACCs (Figure 3). In patients harboring sinus malignancies, orbital invasion via the periorbita is generally associated with poorer OS and DFS rates. Indeed, orbital invasion is associated with worse patients outcomes even following salvage surgery, with reported 5-year survival rate was no more than 40% in patients exhibiting orbital invasion [12]. Orbital exenteration is a procedure that is frequently performed for patients exhibiting tumor invasion of sinus structures, particularly in cases of the medial rectus muscle, optic nerve, or ocular bulb invasion. However, the benefits of this procedure to patients OS or DFS remain unclear, particularly in individuals with residual visual function. As orbital exenteration was not performed in this study, the survival benefits of our procedures were not assessed. However, we achieved orbital tumor recurrence rates of just 13% (3/23), and the total rate of local recurrence (7/44) was not significantly associated with the 5-year OS of patients, indicating that orbital resection may not be so radical during EES for locally advanced SNACCs.
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