| Invited Lecture (JSGS) |
| Fri. November 2nd 9:00 - 9:40 Room 3: Kobe International Exhibition Hall No.2 Building Conference Room 3A |
| Pelvic exenteration: The evolution of radical surgical techniques for advanced and recurrent pelvic malignancy | |||
| Michael J Solomon | |||
| Surgical Research at the RPA Institute of Academic Surgery, The University of Sydney | |||
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| Pelvic exenteration refers to radical multi-visceral resection of locally advanced or recurrent tumours of the pelvis. En bloc resection of all contiguously involved anatomical structures is performed with a view to achieving a complete oncological resection (R0 resection). The primary justification of such radical surgery is the reasonable chance of cure which is now achievable in up to 63% of patients. R0 resection is the most important factor in predicting survival and quality of life after surgery and has therefore become the holy grail of pelvic exenteration. Although most contemporary exenteration units focus on advanced and recurrent rectal cancer, there remains a role for pelvic exenteration in managing various tumours arising from the gastrointestinal or genitourinary tract. When pelvic exenteration was first described in 1948 for recurrent carcinoma of the cervix the survival outcomes were poor and the operative mortality rates as high as 23-35%. Due to these poor early outcomes the second half of the 20th century saw few centres practicing exenteration surgery in any meaningful numbers. With advances in anaesthesia, blood transfusion, medical imaging, intensive care medicine, multi-disciplinary teamwork and surgical technique, increasingly radical ‘higher and wider’ resections are now performed safely with improved outcomes at more units worldwide. This talk describe the novel surgical approaches and surgical anatomy we have taken to the most difficult compartments of the pelvis, including the world’s largest experience of sacrectomy (280), lateral pelvic compartment (>200 cases) radical approach to the neurovascular structures of the lateral pelvic compartments, novel techniques of vascular reconstruction, novel approaches to resect the pubic bone both partial and complete to give a greater anterior margin. Most importantly I will discuss the results of long term (5-10years) survival and quality of life as well as the trajectory to return of quality of life over 2 years after exenteration including cost effectiveness and cost-utility compared to palliative care alone. Finally, a discussion of what the future holds for pelvic exenteration in the 21st century. |
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