Long-term follow-up (seven to fifteen years) of neocystectomy in survivors following multivisceral pelvic surgery

✍ Scribed by N. William Wawro

• Publisher: John Wiley and Sons
• Year: 1967
• Tongue: English
• Weight: 366 KB
• Volume: 20
• Category: Article
• ISSN: 0008-543X
• DOI: 10.1002/1097-0142(196711)20:11<1832::aid-cncr2820201105>3.0.co;2-6

✦ Synopsis

Both ileal conduit of the bladder and ureterosigmoidostomy appear to be satisfactory methods of urinary diversion when neocystectomy is required following radical surgery for advanced pelvic cancer. Maintenance of adequate renal function and continued satisfactory radiographic visualization of the kidneys in such long-term (7 to 15 years) survivors is documented. The advantages and indications for these two techniques are discussed. When advanced pelvic cancer can be controlled by radical pelvic multivisceral resection, sacrifice of the urinary bladder and transplantation of normal or hydronephrotic renal units should not result in deterioration of renal function. UMMULATIVE EXPERIENCE FROM SEVERAL c centers clearly indicates that the welldesigned and executed pelvic multivisceral resection-radical removal of the uterus, cervix, vagina and/or bladder and rectum with associated pelvic lymphatics-for advanced pelvic cancer can give a 5-year salvage rate of approximately 20x.28 395

Since cancer of the cervix uteri tends to remain localized in the pelvis, it is the prime organ for this procedure but an occasional corpus uteri, ovarian, bladder, vaginal, vulva1 and rectal lesion following limited surgery and/or previous radiation, when properly selected, becomes suitable for pelvic exenteration. This salvage rate is superior to that achieved for primary esophageal, pancreatic and gastric neoplasms. Furthermore, this curability rate denies the concept that radiationresistant cancer of the cervix is inherently more malignant and, accordingly, incurable with any modality, as expressed by Heyman4 from the Radiumhemmet Institute in Stockholm.

Except for that patient who has a posterior bladder-sparing exenteration, the control and management of patients with advanced pelvic cancer demands a thorough understanding of the problems relating to urinary diversion and neocystectomy. An uncomplicated adjunctive neocystectomy can add many com-