Modified posterior pelvic exenteration with pelvic side-wall resection requiring both intestinal and urinary reconstruction during surgery for ovarian cancer

Because of the anatomic proximity of the rectosigmoid to the female pelvic organs and its frequent involvement in ovarian cancer, an en bloc resection of ovarian tumors together with the uterus and rectosigmoid, also known as a modified posterior pelvic exenteration (MPPE), is frequently performed t...

Full description

Saved in:
Bibliographic Details
Published in:Gynecologic oncology 2019-10, Vol.155 (1), p.172-173
Main Authors: Kato, Kazuyoshi, Omi, Makiko, Fusegi, Atsushi, Takeshima, Nobuhiro
Format: Article
Language:English
Subjects:
Modified posterior pelvic exenteration
Ovarian cancer
Partial ureterectomy
Ureteroneocystostomy
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Because of the anatomic proximity of the rectosigmoid to the female pelvic organs and its frequent involvement in ovarian cancer, an en bloc resection of ovarian tumors together with the uterus and rectosigmoid, also known as a modified posterior pelvic exenteration (MPPE), is frequently performed to achieve optimal cytoreduction [1]. Additionally, if the tumor has infiltrated the pelvic side-wall, a MPPE combined with pelvic side-wall resection can be selected [2]. We report the details of a technique for this surgery requiring intestinal and urinary reconstruction. A 55-year-old woman underwent an up-front cytoreductive surgery for FIGO stage IIIC (pT3c N1 M0) ovarian cancer. Preoperatively, a tumor infiltrating the left pelvic side-wall was suspected; however, hydronephrosis of the left kidney was not observed on an enhanced computed tomography examination. During a laparotomy, tumor involvement of the left ureter and internal iliac vessels was observed; a MPPE with pelvic side-wall resection including a partial ureterectomy was thus performed. After the resection of the pelvic and omental tumors, colorectal and vesicoureteral anastomoses were performed. Histopathologically, a high-grade serous adenocarcinoma spreading into the muscular layer of the rectum, located close to the ureter and artery, and within 5 mm of the left pelvic side-wall was identified. Diet intake was started on postoperative day (POD) 3. The indwelling bladder catheter was removed on POD 10. Spontaneous voiding after surgery was sufficient and the volume of postvoid residual urine was noted to be
ISSN:0090-8258
1095-6859
DOI:10.1016/j.ygyno.2019.07.015