Laparoscopic Posterior Exenteration in Advanced Gynecologic Malignant Disease

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• 作者：Shailesh Puntambekar ; Saravana Rajamanickam ; Geetanjali Agarwal ; Saurabh Joshi ; Neeraj Rayate ; Avanish Deshmukh
• 关键词：Cervical cancer ; Exenteration ; Laparoscopy
• 刊名：Journal of Minimally Invasive Gynecology
• 出版年：2011
• 出版时间：January-February 2011
• 年：2011
• 卷：18
• 期：1
• 页码：59-63
• 全文大小：153 K

文摘

Study Objective

To study the feasibility, morbidity, and oncologic outcome of laparoscopic posterior exenteration in patients with advanced gynecologic malignant diseases.

Design

Retrospective study based on clinical experience (Canadian Task Force classification III).

Setting

Private hospital.

Patients

The medical records for 10 patients who underwent laparoscopic posterior exenteration because of advanced gynecologic malignant disease were retrospectively reviewed.

Intervention

Laparoscopic posterior exenteration involving selective resection of the uterus, ovaries, vagina, and rectum was performed using a 6-port technique that included harmonic shears, the LigaSure device, and a circular endostapling instrument.

Measurements and Main Results

Histopathologic diagnosis included carcinoma of the cervix in 5 patients, ovary in 4 patients, and vagina in 1 patient. Indication for surgery was primary disease in 7 patients and secondary disease in 3 patients. Complications included delayed bladder recovery in 4 patients, and anastomotic leak, wound infection, and prolonged ileus in 1 patient each. No conversions to open surgery were required. The extent of resection was supralevator in 8 patients and infralevator in 2. Median operative time was 210 minutes. Median length of hospital stay was 9 days. Median blood loss was 360 mL. Disease recurred in 1 patient. After a median follow-up of 26 months, 9 patients were alive, and 8 were free of disease.

Conclusion

Laparoscopic posterior exenteration is feasible in advanced gynecologic malignant disease with rectal involvement. In addition to the known benefits of laparoscopic surgery, carefully selected patients could achieve a survival benefit following R0 resection.