Development of the surgery method of pelvic floor reconstruction in locally advanced cervical cancer after exenteration

Abstract

Background: It is assured that small pelvic exenteration (SPE) is most effective in the treatment of locally advanced and recurrent cervical cancer (CC). Methods: 88 (100%) patients with locally advanced CC were included in this research, divided into 2 groups: 1st group - 62 (70.5%) patients after anterior SPE without plastic reconstruction of pelvic floor (PRPF) and the 2nd group - 26 (30%) patients after anterior SPE who underwentPRPF with a skin graft. Morphologically, squamous cell carcinoma and adenocarcinoma was diagnosed in 76 (86.3%) and 12 patients (13.7%), respectively. 27 (30.7%) patients received chemotherapy, 31 (35.2%) - chemoradiotherapy, and 28 (31.9%) radical radiation therapy. Surgical treatment (non-radical surgery) with chemoradiotherapy was performed only in the case of 2 (2.3%) patients. Results: Based on this data, there are several indications for SPE: Recurrent bleeding from the genital tract, vaginal discharge (vesicovaginal fistulas), hematuria, chronic pain syndrome, ureterohydronephrosis (bilateral or unilateral), extremely low quality of life. The following urine derivation methods were performed: ureterocutaneostomy (UCS), Brikker's operation, colonic urinary reservoir with controlled emptying (self-catheterization) - in 24 (27.3%), 35 (39.8%) and 29 (33%) patients accordingly. Unfortunately, there are complications after SPE: 1 group - there was an intestinal obstruction in 4 patients (4.5%) in the early postoperative period (in these cases it was performed); In 8 patients (9.1%) rectovaginal fistula occurred; purulent-inflammatory processes including pyelonephritis were observed in 13 (14.8%) patients. In the 2nd group - there were purulent-inflammatory processes in 5 patients (5.7%); self-catheterization difficulties - in 2 patients (2.3%), and ureteral anastomotic stricture in 1 (1.1%) patient. Conclusions: It is clear that the developed procedure of pelvic floor reconstruction after SPE, especially with formation of colonic urinary reservoir with controlled emptying, is the most optimal surgical method and it significantly improves patients quality of life.