title: Laparoscopic salvage total pelvic exenteration: Is it possible post-chemo-radiotherapy?
abstract: Indications for total pelvic exenteration in a male (removal of the bladder, prostate and rectum) and in a woman (removal bladder, uterus, vagina, ovaries and rectum) are rare. The advanced stage generally dictates that the patient has some form of chemotherapy or radiotherapy, or a combination of two to shrink/debulk the tumour. We report the first two cases of a salvage laparoscopic total pelvic exenteration in a male for rectal adenocarcinoma invading into the bladder and prostate, post-chemo-radiotherapy and in a woman for squamous cell carcinoma of cervix invading the bladder and rectum post-chemo-radiotherapy. Salvage surgery is often difficult and has been noted to have high morbidity. Applying a laparoscopic approach to this group may have advantages for the patient and the surgeon, i.e. less pain, early recovery and magnified views. As we have technically shown it to be possible, perhaps laparoscopic approaches should be discussed if the teams in these centres are of advanced laparoscopic surgeons working in multi-skilled groups.
authors.affiliation: Section of Laparoscopic Urology, Institute of Urology, University College Hospital, London, UK.
authors.forename: H
authors.initials: H
authors.lastname: Patel
authors.forename: J V
authors.initials: JV
authors.lastname: Joseph
authors.forename: A
authors.initials: A
authors.lastname: Amodeo
authors.forename: K
authors.initials: K
authors.lastname: Kothari
references.citation: Gynecol Oncol. 2006 Dec;103(3):1023-30
references.pmid: 16890276
references.citation: Gynecol Oncol. 1988 Sep;31(1):205-16
references.pmid: 3410348
references.citation: Br J Obstet Gynaecol. 1994 Jun;101(6):529-31
references.pmid: 8018644
references.citation: Surg Clin North Am. 1969 Apr;49(2):431-47
references.pmid: 4886910
references.citation: Gynecol Oncol. 1995 Feb;56(2):207-10
references.pmid: 7896187
references.citation: Obstet Gynecol. 1989 Jun;73(6):1027-34
references.pmid: 2726106
references.citation: Obstet Gynecol. 1989 Dec;74(6):934-43
references.pmid: 2586960
references.citation: Int J Gynecol Cancer. 2005 May-Jun;15(3):475-82
references.pmid: 15882172
references.citation: Gynecol Oncol. 1989 Jun;33(3):279-82
references.pmid: 2722049
references.citation: Am J Obstet Gynecol. 1985 May 1;152(1):12-6
references.pmid: 2581447
references.citation: Am J Obstet Gynecol. 1975 Apr 1;121(7):907-18
references.pmid: 1115180
references.citation: Gynecol Oncol. 1997 Jan;64(1):130-5
references.pmid: 8995561
references.citation: Gynecol Oncol. 1989 Oct;35(1):93-8
references.pmid: 2792911
references.citation: Ann Surg Oncol. 1998 Jul-Aug;5(5):399-406
references.pmid: 9718168
references.citation: Int J Gynecol Cancer. 2005 Jul-Aug;15(4):624-9
references.pmid: 16014116
references.citation: Gynecol Oncol. 2003 Nov;91(2):369-77
references.pmid: 14599868
references.citation: Cancer. 1948 Jul;1(2):177-83
references.pmid: 18875031
references.citation: Am J Obstet Gynecol. 1977 Dec 15;129(8):881-92
references.pmid: 930972
references.citation: Surg Oncol Clin N Am. 2005 Apr;14(2):289-300
references.pmid: 15817240
references.citation: Semin Surg Oncol. 1999 Oct-Nov;17(3):161-7
references.pmid: 10504663
references.citation: Lancet. 2002 Jun 29;359(9325):2224-9
references.pmid: 12103285
references.citation: Gynecol Oncol. 2005 Oct;99(1):153-9
references.pmid: 16054678
references.citation: Semin Surg Oncol. 1999 Apr-May;16(3):236-41
references.pmid: 10225302
references.citation: Gynecol Oncol. 2002 Sep;86(3):311-5
references.pmid: 12217753