Laparoscopic-Assisted Vaginal Pelvic Exenteration and Reconstructive Procedure

María Dolores Diestro Tejeda, Begoña Díaz de la Noval, Ignacio Javier Brunel García, Ignacio Zapardiel, Alicia Hernández Gutiérrez and J De Santiago García

Department of Gynecology Oncology Unit, La Paz University Hospital, Spain
Hospital Quirón Madrid, Spain

^*Correspondance to: Begoña Díaz de la Noval 

 PDF  Full Text Case Report | Open Access

Abstract:

Introduction: Total pelvic exenteration is an ultra-radical surgical approach which involves an enbloc resection of the tumor and pelvic organs affected. The procedure is performed with a curative intention in recurrent or advanced gynecological malignancies. The aim of this video is to describe a step by step video presentation of the surgical and reconstructive procedure.Case Report: A 46-year old woman, previous stage IA vaginal carcinoma treated with radiotherapy. Two years after, she has a 5 centimeters centropelvic relapse that compromises pelvic organs, no pelvic wall infiltration or metastasis. A total type I pelvic exenteration with vulvectomy is performed. The surgical procedure involves four steps: (1^st) diagnostic laparoscopy, (2^nd) laparoscopic total supraelevator pelvic exenteration with perineal-rectal vaginal resection, (3^rd) urinary (Bricker´s technique) and digestive (colostomy) diversions performed extracorporeally, (4^th) pelvic floor reconstruction with a biological mesh and bilateral gracilis myocutaneous flaps as a neovagina. Postsurgical minor complications were superficial ischemia of gracilis flaps, pyelonephritis, and recurrent pelvic abscess. The tumor was a high grade invasive squamous carcinoma with lymphovascular invasion and free surgical margins but microscopic residual tumor in the parametrium. Due to complications, adjuvant treatment could not be performed; the patient had a metastatic relapse a year later, she died. The radical excision of locally advanced gynecological cancers may produce a wide defect of perineal tissue that predisposes to complications, so pelvic floor reconstruction is recommended.Discussion: Morbidity is close to 50%, OS and DFS 40 and 60% respectively. Prognostic factors are residual tumor, tumor size greater than 5 cm and lymph node involvement. Surgical rescue by pelvic exenteration should be seen as part of a multidisciplinary and experienced team.Conclusion: Laparoscopy in pelvic exenteration is feasible in selected cases and reconstruction procedure should include proper handling of the pelvic floor.

Keywords:

Laparoscopy; Minimally invasive surgery; Pelvic exenteration; Pelvic floor reconstruction; Vaginal carcinoma

Cite the Article:

Diestro Tejeda MD, Díaz de la Noval B, Brunel García IJ, Zapardiel I, Hernández Cutiérrez A, De Santiago García J. Laparoscopic-Assisted Vaginal Pelvic Exenteration and Reconstructive Procedure. Ann Clin Case Rep. 2016; 1: 1159.