Laterally extended endopelvic resection: surgical treatment of infrailiac pelvic wall recurrences of gynecologic malignancies

Am J Obstet Gynecol. 1999 Feb;180(2 Pt 1):306-12. doi: 10.1016/s0002-9378(99)70204-8.

Abstract

Objective: My purpose was to treat infrailiac pelvic wall recurrences of gynecologic malignancies with extended radical surgery.

Study design: On the basis of cadaver dissection studies, I developed the laterally extended endopelvic resection techniques. The new operations were offered to patients with infrailiac sidewall disease during a 3-year feasibility study.

Results: Laterally extended endopelvic resections extending the lateral resection plane of pelvic exenteration to the medial aspects of the acetabulum, obturator membrane, sacrospinous ligament, and sacral plexus/piriformis muscle were performed in 18 consecutive patients. After this procedure, all patients had tumor-free intraoperative biopsy specimens taken from the remaining pelvic wall structures within the tumor bed area. The final histopathologic report confirmed clean margins in 6 patients and margins with microscopic tumor extensions only in 12 patients. Severe complications occurred in 4 patients (22%), without treatment-related deaths.

Conclusion: Laterally extended endopelvic resection allows the complete surgical removal of infrailiac pelvic-side-wall tumors, the most frequent local recurrence of lower genital tract cancer, either with free margins or with potential microscopic residual tumor as a prerequisite for combined operative and radiation treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Combined Modality Therapy
  • Female
  • Humans
  • Pelvic Exenteration / methods*
  • Pelvic Neoplasms / radiotherapy
  • Pelvic Neoplasms / secondary*
  • Pelvic Neoplasms / surgery*
  • Survival
  • Uterine Cervical Neoplasms / mortality
  • Uterine Cervical Neoplasms / pathology
  • Vulvar Neoplasms / mortality
  • Vulvar Neoplasms / pathology