Laterally extended endopelvic resection: surgical treatment of infrailiac pelvic wall recurrences of gynecologic malignancies.

Abstract

My purpose was to treat infrailiac pelvic wall recurrences of gynecologic malignancies with extended radical surgery. On the basis of cadaver dissection studies, I developed the laterally extended endopelvic resection techniques. The new operations were offered to patients with infrailiac sidewall disease during a 3-year feasibility study. Laterally extended endopelvic resections extending the lateral resection plane of pelvic exenteration to the medial aspects of the acetabulum, obturator membrane, sacrospinous ligament, and sacral plexus/piriformis muscle were performed in 18 consecutive patients. After this procedure, all patients had tumor-free intraoperative biopsy specimens taken from the remaining pelvic wall structures within the tumor bed area. The final histopathologic report confirmed clean margins in 6 patients and margins with microscopic tumor extensions only in 12 patients. Severe complications occurred in 4 patients (22%), without treatment-related deaths. Laterally extended endopelvic resection allows the complete surgical removal of infrailiac pelvic-side-wall tumors, the most frequent local recurrence of lower genital tract cancer, either with free margins or with potential microscopic residual tumor as a prerequisite for combined operative and radiation treatment.