Role of Exenterative Surgery in Locally Advanced Pelvic Tumours.

Govindaraj, G (2008) Role of Exenterative Surgery in Locally Advanced Pelvic Tumours. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION : Total pelvic exenteration is a radical procedure defined as the complete resection of the pelvic viscera and its draining lymphatic system. Ever since Brunschwig published his initial experience in 1948 about sixty years ago, the procedure has undergone a major evolution from being a desperate experimental procedure to a well established surgical procedure with curative intent for selected patients. In an era of multimodal treatment and organ preservation, exenteration still maintains an important place in the armamentarium against advanced pelvic malignancy. The rationale for such an ultra-radical procedure is based on the observation by Eugene M Bricker, a pioneer in pelvic exenteration, along with pathologist Lauren Ackerman, radiotherapist Theodore Eberhart and Dr.Juan del Regato that certain cancers of the pelvic viscera possessed a propensity for remaining confined to the pelvic organs for a long time before they metastasize. The classic examples are the cancers arising from the uterine cervix, vagina, vulva and rectosigmoid. Ovarian, prostate and to a lesser extent bladder and endometrial cancers most often spread beyond pelvis by the time adjacent viscera are involved. AIM : The study aims to analyze the various indications, preoperative evaluation, technique, morbidity, mortality and outcome of pelvic exenterations done at the surgical oncology department of Government Royapettah hospital and to compare the results with similar international series to evaluate the role of exenterative pelvic surgery in today’s practice. CONCLUSION : The indolent behavior of certain pelvic cancers is what makes pelvic exenteration a feasible procedure for the cure of locally advanced neoplasms. Pelvic exenteration today must be viewed in the context of a salvage operation aimed at a potential cure, not primarily as a palliative effort. This daunting procedure must be performed by surgeons experienced in multivisceral resections, in an environment in which pelvic reconstruction, patient rehabilitation, and interdisciplinary cancer care are provided with the leadership of surgeons who understand and embrace multimodal treatment of patients with cancer. Several recent publications attest to the increasing use of this procedure internationally. Our analysis shows that the procedure can be done with acceptable complications and is the only curative hope in selected patients. Though organ preservation and minimal approach surgery is the recent trend in surgical management, there exists a small but definite place for this procedure in the surgical management of locally advanced pelvic tumors who have exhausted all other modalities of treatment.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Exenterative Surgery ; Locally Advanced Pelvic Tumours.
Subjects: MEDICAL > Surgical Oncology
Depositing User: Kambaraman B
Date Deposited: 25 Jul 2017 03:24
Last Modified: 25 Jul 2017 03:24

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