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Palliation in advanced pelvic and perineal neoplasms: Which Procedure and Why

par Anaf, Vincent ;El Nakadi, Issam ;Simon, J.;Van Geertruyden, Jean ;Defontaine, S.;Goldsehmidt, D.;Simon, Philippe ;Noël, Jean Christophe
Référence Journal of pelvic medicine and surgery, 4, 4, page (167-173)
Publication Publié, 1998

Article révisé par les pairs

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Résumé :

Objectives By reviewing two selected case reports and the literature, the indications for palliative surgery in advanced pelvic neoplasms, the procedures involved, and the expected results are presented. Background There is a natural reticence among pelvic surgeons to perform extensive surgery in known palliative situations. Nevertheless, some patients with advanced pelvic or perineal cancer have incapacitating pain or intolerable discharge and bleeding, and a palliative procedure may improve the quality of life, if even for a short time interval. For select patients for whom all other primary treatments were unsuccessful, those who are well motivated, well informed, and in good general health may be candidates for a palliative surgical approach. The safest surgical intervention should be performed to avoid prolonged postoperative hospital stay or perioperative morbidity. When possible, tumor clearance is achieved by infralevator exenteration plus, when indicated, radical or extended vulvectomy. Discussion Pelvic floor reconstruction using a rectus abdominis myocutaneous flap is recommended, along with a noncontinent Bricker or Wallace procedure for urinary diversion. Although aggressive, such palliative procedure improves quality of life for some patients by eliminating pain and discharge. A multidisciplinary team involving pelvic surgeons, pathologists, experienced nursing staff, and psychosexual and stomal therapists is needed to achieve maximum rehabilitation. Conclusions In the future, increased experience with intraoperative radiotherapy (IORT) hopefully will extend disease-free and symptom-free intervals for patients with advanced pelvic or perineal neoplasms. © 1998 Lippincott Williams & Wilkins, Inc.