title: Laterally extended endopelvic resection: surgical treatment of infrailiac pelvic wall recurrences of gynecologic malignancies.
abstract: OBJECTIVE
  My purpose was to treat infrailiac pelvic wall recurrences of gynecologic malignancies with extended radical surgery.
  
  
  METHODS
  On the basis of cadaver dissection studies, I developed the laterally extended endopelvic resection techniques. The new operations were offered to patients with infrailiac sidewall disease during a 3-year feasibility study.
  
  
  RESULTS
  Laterally extended endopelvic resections extending the lateral resection plane of pelvic exenteration to the medial aspects of the acetabulum, obturator membrane, sacrospinous ligament, and sacral plexus/piriformis muscle were performed in 18 consecutive patients. After this procedure, all patients had tumor-free intraoperative biopsy specimens taken from the remaining pelvic wall structures within the tumor bed area. The final histopathologic report confirmed clean margins in 6 patients and margins with microscopic tumor extensions only in 12 patients. Severe complications occurred in 4 patients (22%), without treatment-related deaths.
  
  
  CONCLUSIONS
  Laterally extended endopelvic resection allows the complete surgical removal of infrailiac pelvic-side-wall tumors, the most frequent local recurrence of lower genital tract cancer, either with free margins or with potential microscopic residual tumor as a prerequisite for combined operative and radiation treatment.
authors.affiliation: Department of Obstetrics and Gynecology, University of Leipzig, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Höckel
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D010385:Pelvic Exenteration / Q000379:methods*; D010386:Pelvic Neoplasms / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery*; D013534:Survival; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology; D014846:Vulvar Neoplasms / Q000401:mortality / Q000473:pathology