Primer ve nüks jinekolojik vakalarda pelvik egzenterasyon

Yıl 2023, Cilt: 23 Sayı: 2, 23 - 32, 06.11.2023

Tuğçe Sırma Yunus İlhan Levent Akman Mustafa Coşan Terek Ahmet Aydın Özsaran Nuri Yıldırım

Öz

Giriş: Pelvik ekzenterasyon, seçilmiş lokal ileri ever tümörler ve özellikle tekrarlayan kanserler için genellikle tek küratif tedavi seçeneğidir. Bu çalışmanın primer amacı, kliniğimizde pelvik ekzenterasyon operasyonu geçiren hastaların klinik özelliklerini, tiplerini ve operatif ve postoperatif komplikasyon sıklığını değerlendirmektir.
Gereç ve Yöntem: Kliniğimizde 2019-2023 yılları arasında primer ve nüks jinekolojik tümör nedeniyle pelvik ekzenterasyon yapılan 14 hasta retrospektif olarak değerlendirildi.
Bulgular: Tüm hastalara anterior, posterior ve total ekzenterasyon uygulandı. Ortalama yaş 56 (26-71 yaş arası) idi. Pelvik ekzenterasyonun en sık nedenleri servikal kanser (n=5, %35,7) ve over kanseriydi (n=5, %35,7). Ekzenterasyon öncesi hastaların %28,5'ine neoadjuvan kemoterapi, %35,7'sine primer kemo- radyoterapi ve 3 hastaya preoperatif tedavi verilmemiştir. Üriner diversiyon şekli ileum konduit (%64,2) idi. Ortalama operasyon süresi, tahmini kan kaybı ve hastanede kalış süresi 420 dakika, 2 ünite ve 25 gündü. Hiçbir intraoperatif komplikasyon görülmedi. Toplam morbidite oranı %28,5; hastaların %7,1'inde erken komplikasyon (ameliyattan <30 gün sonra), 3 hastada (% 21,4) geç komplikasyon görüldü. Hiçbir hastada reoperasyon gerekmedi. Hastaların %50'sinde nüks gelişti. Postoperatif (ameliyattan <30 gün sonra) veya intraoperative ölüm olmadı. Sekiz hasta maligniteden ötürü vefat etti. Çalışmamızda kısa takip süresi nedeniyle sağkalım değerlendirilemedi.
Sonuç: Lokal invaziv veya nüks jinekolojik tümörler için pelvik ekzenterasyon, yüksek komplikasyon oranları ve hastanede kalış süresi olan, tek küratif cerrahi yöntemdir.

Anahtar Kelimeler

pelvik egzenterasyon, rekürrens, jinekolojik kanser, prognoz

Pelvic Exenteration for Primary or Recurrent Gynecologic Malignancy

Öz

Introduction: Pelvic exenteration is often the only curative treatment option for selected locally advanced tumors, and especially for recurrent cancers. The primary aim of this study is to assess the clinical features, types and frequency of operative and postoperative complications of patients who underwent pelvic exenteration operation by our clinic.
Material and Methods: Retrospectively, between 2019 and 2023, 14 patients with primary and recurrent gynecologic tumors who underwent pelvic exenteration were assessed in our clinic.
Findings: All patients treated with anterior, posterior and total exenteration. Mean age was 56 (range, 26-71 years). The most primary tumors were cervical cancer (n=5, 35.7%) and ovarian cancer (n=5, 35.7%). 28.5% of patients received neoadjuvant chemotheraphy before exenteration, 35.7% of patients were treated with primary chemo-radiotheraphy and 3 patients didn't receive preoperative treatment. Urinary diversion was ileum conduit (64.2%). Mean operation time, estimated blood loss and hospital stay were 420 minutes, 2 units and 25 days. There were no intraoperative complications. Total morbidity rate was 28.5%; 7.1% of patients had early complications (<30 days after surgery) whereas 3 patients (21.4%) had late complications. Re-operation was not required in any patients. Disease recurrence occurred in 50% patients. There were no post-operative deaths (<30 days from surgery) nor intra-operative mortality. Eight patients died from recurrent malignancy. In our study survival was not assessed because of the short follow-up time.
Results and conclusion: Pelvic exenteration is the only curative surgical method in locally invasive or recurrent gynecological tumors, with high complication rates and hospital stays.

Anahtar Kelimeler

Pelvic exenteration, Recurrence, Gynecologic cancer, Prognosis, Cervical cancer

Kaynakça

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