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Pelvic Surgery

Pelvic Surgery Hindawi Publishing Corporation International Journal of Surgical Oncology Volume 2012, Article ID 287096, 2 pages doi:10.1155/2012/287096 Editorial 1, 2 3, 4 Constantine P. Karakousis and Harold Wanebo Department of Surgery Buffalo General Hospital, 100 High Street, Buffalo, NY 14203, USA State University of New York at Buffalo, 408 Capen Hall, Buffalo, NY 14260, USA Landmark Medical Center, Woonsockett, RI, USA Boston University, One Silber Way, Boston, MA 02215, USA Correspondence should be addressed to Constantine P. Karakousis, ckarakousis@kaleidahealth.org Received 4 July 2012; Accepted 4 July 2012 Copyright © 2012 C. P. Karakousis and H. Wanebo. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The present issue of the International Journal of Surgical The article “Total pelvic exenteration (PE) for gyneco- Oncology on Pelvic Surgery contains a series of articles on logical malignancies” by Diver et al. describes PE as the en- prostate cancer, gynecologic malignancies, and rectal cancer. bloc resection of pelvic organs including reproductive struc- The article on “radical prostatectomy as a first-line tures, bladder, and rectosigmoid. It is commonly indicated treatment in patients with initial PSA >20 ng/mL” by for advanced primary or locally recurrent cancer without Hinev et al. reports on patients diagnosed with prostate evidence of metastatic disease or elements which preclude cancer (PCa) and PSA >20 ng/mL. The elevated PSA level resection. Major complications occur in as many as 50% of is considered an adverse prognostic factor in PCa often the patients. In carefully selected patients with gynecologic regarded as contraindication to radical surgery. The authors cancer PE can be curative. Separate stomata for urine and purported to estimate the impact of radical prostatectomy fecal diversion and the use of omentum to protect and cover (RP) on biochemical-recurrence-(BCR-) free and cancer the denuded surfaces and more recently development of specific survival (CSS) for these patients. Men in this group techniques to remove involved pelvic side wall have increased had significantly lower 10-year BCR-free and CSS rates the chance of curative surgery. Laparoscopic and robotic- than patients with initial PSA <20 ng/mL (20.7% versus assisted technology has improved operative recovery while 79.6%/P< 0.001/and 65% versus 87.9%/P = 0.01, resp.). a5-yearsurvivalrateofabout 50% hasbeenreported. Pathological stages were found to be independent predictors Various techniques for functional neovaginas have been of PSA failure in men with PSA >20 ng/mL. Patients with developed. Anterior and posterior exenteration techniques favorable prognostic variables (pT2, NO) had significantly are described. PE is usually performed with curative intent longer disease-free and overall survival similar to those with but palliative PE has been used in cases mainly of severe initial PSA <20 ng/mL. High PSA values do not indicate radiation necrosis. The authors describe extensively compli- poor prognosis uniformly and therefore along with patients cations and quality of life after PE and provide useful overall with organ-confined PCa and negative lymph nodes may information in doing PE for gynecological malignancies. benefit from RP. In one series more than 50% of patients The article by A. F. R. Cubal et al. on “Fertility-sparing with initial PSA values above 20 ng/mL had undetectable PSA surgery for early-stage cervical cancer” reviews data on pro- values over the first 5-years after RP. Similar results have cedures for fertility preservation, that is, vaginal and abdom- been reported in other series with RP used as monotherapy. inal trachelectomy. The overall oncologic safety is good Neoadjuvant hormonal therapy is no longer recommended compared to radical hysterectomy offered traditionally and for patients subjected to radical surgical treatment. The the obstetrical outcomes are promising. Good selection of authors suggest further studies in patients with initial PSA patients and complete information with a detailed informed values >20 ng/mL and use of RP in order to verify the results consent is required. The authors describe the eligibility of their study. criteria in terms of tumor dimensions, depth of invasion, 2 International Journal of Surgical Oncology type and grade and lymphovascular space involvement. The for intraperitoneal spread of ovarian cancer, the 5-year procedures of vaginal and abdominal radical trachelectomy survival being about 30% the role of secondary cytoreductive aredescribed,aswellasthe follow-upand useoflessradical surgery for recurrent disease is controversial. The authors procedures. Neoadjuvant chemotherapy has been employed discuss on how to identify patients most likely to benefit in women with larger cervical lesions (>2cm) in order to from a secondary cytoreduction and the prognostic factors decrease the tumor size and provide a more conservative for survival of whom complete debulking is the strongest endocervical tissue resection. In conclusion, radical vaginal predictor. Absence of ascites and reintroduction of platinum trachelectomy is a well-established safe procedure for early are also associated with prolonged survival. In addition, cervical cancer (<2 cm) with good oncological and obstet- the authors address the issue of cytoreductive surgery rical outcomes and low morbidity-mortality rates. Open and hyperthermic intraperitoneal chemotherapy (HIPEC). abdominal or laparoscopic approaches are increasingly used HIPEC has attracted considerable interest due to promising which along with robotic surgery will provide more surgical results in peritoneal colon cancer carcinomatosis but in options for these patients. ovarian carcinomatosis the survival benefit is not evident The article on “The Retrograde and Retroperitoneal requiring a well designed prospective randomized phase III Totally Laparoscopic Hysterectomy for Endometrial Cancer” Trial. The authors believe that there is a role for secondary by E. Volpe et al. describes their experience for total laparo- cytoreductive surgery in well selected patients (absence of scopic hysterectomy based on completely retrograde and ascites, good performance status and complete debulking). retroperitoneal technique for surgical staging and treatment Constantine P. Karakousis of endometrial cancer. The technique used was based on a Harold Wanebo combination of a retroperitoneal approach with a retrograde and lateral dissection of the bladder and retrograde culdo- tomy with variable resection of parametrium. The authors’ laparoscopic technique and retroperitoneal approach allows control of the main uterine vessels, constant monitoring of the ureters and exposure and removal of the lymph nodes as needed. The procedure has been used in 95 patients (Jan 2002–Dec 2011). It has cost savings implications and does not require a uterine manipulator which is, when used, a concern for possible dissemination of tumor. The article on “Intersphincteric resection and coloanal anastomosis in the treatment of distal rectal cancer” by Gokhan Cipe et al describes clearly the technique of intersphincteric resection providing sphincter saving surgery for patients with distal rectal cancer as an alternative to abdominoperineal resection (APR). The extent of the intersphincteric resection (ISR) is distinguished into partial, subtotal and total. When the tumor spread is to or beyond the dentate line, total ISR should be done. If the distal edge of the tumor is more than 2 cm from the dentate line, subtotal ISR is performed, the distal resection margin being between the dentate line and the intersphincteric groove. When there is sufficient distal surgical margin, the distal line of resection can be on or above the dentate line (partial ISR). The common complications of ISR are anastomotic leakage, stricture, fistula, pelvic sepsis, bleeding etc. ISR has rates of local recurrence between 2% and 3%. The 5-year survival with ISR has been reported to be about 80% and disease-free survival 69%. In some studies the survival after abdominoperitoneal resection (APR) was lower than after ISR. Complete continence after ISR is observed in 30% to 86%, while fecal soiling occurs in 15% to 63% of patients. The authors conclude that sphincter-saving surgery may be the treatment of choice for distal rectal cancer which is of early stage, well differentiated or underwent objective regression after neoadjuvant therapy. The article on “The role of secondary surgery in recurrent ovarian cancer” by D. Lorusso et al. reports that although primary complete cytoreduction and adjuvant Platinum- Paclitaxel chemotherapy is a well established treatment MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 International Journal of Journal of Immunology Research Endocrinology Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Submit your manuscripts at http://www.hindawi.com BioMed PPAR Research Research International Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Research and Treatment Cellular Longevity Neurology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png International Journal of Surgical Oncology Hindawi Publishing Corporation

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Publisher
Hindawi Publishing Corporation
Copyright
Copyright © 2012 Constantine P. Karakousis and Harold Wanebo. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ISSN
2090-1402
eISSN
2090-1410
DOI
10.1155/2012/287096
Publisher site
See Article on Publisher Site

Abstract

Hindawi Publishing Corporation International Journal of Surgical Oncology Volume 2012, Article ID 287096, 2 pages doi:10.1155/2012/287096 Editorial 1, 2 3, 4 Constantine P. Karakousis and Harold Wanebo Department of Surgery Buffalo General Hospital, 100 High Street, Buffalo, NY 14203, USA State University of New York at Buffalo, 408 Capen Hall, Buffalo, NY 14260, USA Landmark Medical Center, Woonsockett, RI, USA Boston University, One Silber Way, Boston, MA 02215, USA Correspondence should be addressed to Constantine P. Karakousis, ckarakousis@kaleidahealth.org Received 4 July 2012; Accepted 4 July 2012 Copyright © 2012 C. P. Karakousis and H. Wanebo. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The present issue of the International Journal of Surgical The article “Total pelvic exenteration (PE) for gyneco- Oncology on Pelvic Surgery contains a series of articles on logical malignancies” by Diver et al. describes PE as the en- prostate cancer, gynecologic malignancies, and rectal cancer. bloc resection of pelvic organs including reproductive struc- The article on “radical prostatectomy as a first-line tures, bladder, and rectosigmoid. It is commonly indicated treatment in patients with initial PSA >20 ng/mL” by for advanced primary or locally recurrent cancer without Hinev et al. reports on patients diagnosed with prostate evidence of metastatic disease or elements which preclude cancer (PCa) and PSA >20 ng/mL. The elevated PSA level resection. Major complications occur in as many as 50% of is considered an adverse prognostic factor in PCa often the patients. In carefully selected patients with gynecologic regarded as contraindication to radical surgery. The authors cancer PE can be curative. Separate stomata for urine and purported to estimate the impact of radical prostatectomy fecal diversion and the use of omentum to protect and cover (RP) on biochemical-recurrence-(BCR-) free and cancer the denuded surfaces and more recently development of specific survival (CSS) for these patients. Men in this group techniques to remove involved pelvic side wall have increased had significantly lower 10-year BCR-free and CSS rates the chance of curative surgery. Laparoscopic and robotic- than patients with initial PSA <20 ng/mL (20.7% versus assisted technology has improved operative recovery while 79.6%/P< 0.001/and 65% versus 87.9%/P = 0.01, resp.). a5-yearsurvivalrateofabout 50% hasbeenreported. Pathological stages were found to be independent predictors Various techniques for functional neovaginas have been of PSA failure in men with PSA >20 ng/mL. Patients with developed. Anterior and posterior exenteration techniques favorable prognostic variables (pT2, NO) had significantly are described. PE is usually performed with curative intent longer disease-free and overall survival similar to those with but palliative PE has been used in cases mainly of severe initial PSA <20 ng/mL. High PSA values do not indicate radiation necrosis. The authors describe extensively compli- poor prognosis uniformly and therefore along with patients cations and quality of life after PE and provide useful overall with organ-confined PCa and negative lymph nodes may information in doing PE for gynecological malignancies. benefit from RP. In one series more than 50% of patients The article by A. F. R. Cubal et al. on “Fertility-sparing with initial PSA values above 20 ng/mL had undetectable PSA surgery for early-stage cervical cancer” reviews data on pro- values over the first 5-years after RP. Similar results have cedures for fertility preservation, that is, vaginal and abdom- been reported in other series with RP used as monotherapy. inal trachelectomy. The overall oncologic safety is good Neoadjuvant hormonal therapy is no longer recommended compared to radical hysterectomy offered traditionally and for patients subjected to radical surgical treatment. The the obstetrical outcomes are promising. Good selection of authors suggest further studies in patients with initial PSA patients and complete information with a detailed informed values >20 ng/mL and use of RP in order to verify the results consent is required. The authors describe the eligibility of their study. criteria in terms of tumor dimensions, depth of invasion, 2 International Journal of Surgical Oncology type and grade and lymphovascular space involvement. The for intraperitoneal spread of ovarian cancer, the 5-year procedures of vaginal and abdominal radical trachelectomy survival being about 30% the role of secondary cytoreductive aredescribed,aswellasthe follow-upand useoflessradical surgery for recurrent disease is controversial. The authors procedures. Neoadjuvant chemotherapy has been employed discuss on how to identify patients most likely to benefit in women with larger cervical lesions (>2cm) in order to from a secondary cytoreduction and the prognostic factors decrease the tumor size and provide a more conservative for survival of whom complete debulking is the strongest endocervical tissue resection. In conclusion, radical vaginal predictor. Absence of ascites and reintroduction of platinum trachelectomy is a well-established safe procedure for early are also associated with prolonged survival. In addition, cervical cancer (<2 cm) with good oncological and obstet- the authors address the issue of cytoreductive surgery rical outcomes and low morbidity-mortality rates. Open and hyperthermic intraperitoneal chemotherapy (HIPEC). abdominal or laparoscopic approaches are increasingly used HIPEC has attracted considerable interest due to promising which along with robotic surgery will provide more surgical results in peritoneal colon cancer carcinomatosis but in options for these patients. ovarian carcinomatosis the survival benefit is not evident The article on “The Retrograde and Retroperitoneal requiring a well designed prospective randomized phase III Totally Laparoscopic Hysterectomy for Endometrial Cancer” Trial. The authors believe that there is a role for secondary by E. Volpe et al. describes their experience for total laparo- cytoreductive surgery in well selected patients (absence of scopic hysterectomy based on completely retrograde and ascites, good performance status and complete debulking). retroperitoneal technique for surgical staging and treatment Constantine P. Karakousis of endometrial cancer. The technique used was based on a Harold Wanebo combination of a retroperitoneal approach with a retrograde and lateral dissection of the bladder and retrograde culdo- tomy with variable resection of parametrium. The authors’ laparoscopic technique and retroperitoneal approach allows control of the main uterine vessels, constant monitoring of the ureters and exposure and removal of the lymph nodes as needed. The procedure has been used in 95 patients (Jan 2002–Dec 2011). It has cost savings implications and does not require a uterine manipulator which is, when used, a concern for possible dissemination of tumor. The article on “Intersphincteric resection and coloanal anastomosis in the treatment of distal rectal cancer” by Gokhan Cipe et al describes clearly the technique of intersphincteric resection providing sphincter saving surgery for patients with distal rectal cancer as an alternative to abdominoperineal resection (APR). The extent of the intersphincteric resection (ISR) is distinguished into partial, subtotal and total. When the tumor spread is to or beyond the dentate line, total ISR should be done. If the distal edge of the tumor is more than 2 cm from the dentate line, subtotal ISR is performed, the distal resection margin being between the dentate line and the intersphincteric groove. When there is sufficient distal surgical margin, the distal line of resection can be on or above the dentate line (partial ISR). The common complications of ISR are anastomotic leakage, stricture, fistula, pelvic sepsis, bleeding etc. ISR has rates of local recurrence between 2% and 3%. The 5-year survival with ISR has been reported to be about 80% and disease-free survival 69%. In some studies the survival after abdominoperitoneal resection (APR) was lower than after ISR. Complete continence after ISR is observed in 30% to 86%, while fecal soiling occurs in 15% to 63% of patients. The authors conclude that sphincter-saving surgery may be the treatment of choice for distal rectal cancer which is of early stage, well differentiated or underwent objective regression after neoadjuvant therapy. The article on “The role of secondary surgery in recurrent ovarian cancer” by D. Lorusso et al. reports that although primary complete cytoreduction and adjuvant Platinum- Paclitaxel chemotherapy is a well established treatment MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 International Journal of Journal of Immunology Research Endocrinology Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Submit your manuscripts at http://www.hindawi.com BioMed PPAR Research Research International Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Research and Treatment Cellular Longevity Neurology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014

Journal

International Journal of Surgical OncologyHindawi Publishing Corporation

Published: Sep 18, 2012

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