title: Out-of-the-box pelvic surgery including iliopsoas resection for recurrent gynecological malignancies: Does that make sense? A single-institution case-series.
abstract: OBJECTIVE
  To report morbidity and oncological outcomes in a consecutive series of lateral isolated recurrent gynecological cancer involving the pelvic side wall (PSW) including the iliopsoas muscle.
  
  
  METHODS
  We retrospectively evaluated a consecutive series between 6/2013 and 12/2015 of lateral isolated recurrent gynecological malignancies treated with a lateral endopelvic resection (LEPR). LEPR was defined as an en-bloc lateral resection of a pelvic tumor with sidewall muscle, and/or bone, and/or major nerve, and/or major vascular structure. Post-surgical complications, quality of life (QoL) and survivals were computed.
  
  
  RESULTS
  Seventy-four women with pelvic isolated relapse were admitted for surgery during the study period. Among them, 8 cases (10.8%) showed lateral isolated relapse involving the iliopsoas muscle and were treated with LEPR. R0 resection was achieved in 6/8 patients (75.0%), while the pathologic margins were microscopically and macroscopically positive in 1 patient (12.5%), respectively. There were no perioperative mortalities. Major postoperative complications occurred in 3 patients (37.5%) through peripheral neuropathies, thrombosis of the vascular graft and compartment syndrome of the leg. Median follow-up time was 21 months (range, 12-28). The 2-year overall survival (OS) was 88% improving up to 100% if R0 resection was achieved. In patients with positive pathologic margins (n = 2), the 2-year OS was 50%. All women showed an improved QoL after surgery.
  
  
  CONCLUSIONS
  LEPR with iliopsoas resection can be safely performed in selected cases with lateral isolated gynecological relapse involving the PSW and was associated with improved QoL and prolonged survival when an R0 resection was achieved.
authors.affiliation: Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Rome, Italy. Electronic address: giuseppevizzielli@yahoo.it.
authors.forename: G
authors.initials: G
authors.lastname: Vizzielli
authors.affiliation: Division of Gynecologic Oncology, University of Palermo, Palermo, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Chiantera
authors.affiliation: Division of Vascular Surgery, "Agostino Gemelli" Foundation University Hospital, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Tinelli
authors.affiliation: Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Fagotti
authors.affiliation: Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Gallotta
authors.affiliation: Division of Surgery, "Agostino Gemelli" Foundation University Hospital, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Di Giorgio
authors.affiliation: Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Gueli Alletti
authors.affiliation: Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Scambia
mesh_terms: D000328:Adult; D000368:Aged; D003161:Compartment Syndromes / Q000453:epidemiology; D018572:Disease-Free Survival; D005260:Female; D006083:Graft Occlusion, Vascular / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000601:surgery*; D010386:Pelvic Neoplasms / Q000601:surgery*; D010523:Peripheral Nervous System Diseases / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D016658:Psoas Muscles / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D013927:Thrombosis / Q000453:epidemiology; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000601:surgery*
keywords: Iliopsoas resection; Lateral endopelvic resection; Pelvic side wall disease; Recurrent gynecological malignancies