Nicolae Bacalbasa

Nicolae Bacalbasa

Posterior Pelvic Exenteration for Atypical Recurrence after Surgically Treated and Irradiated Endometrial Cancer

Endometrial carcinoma is the fifth most common malignancy in women worldwide and the most common gynaecologic cancer in developed countries, being associated with increased fat consumption, obesity and exposure to unopposed estrogens (1,2,3). Endometrial cancer is usually diagnosed in an early stage of the disease
up to 75% of cases are diagnosed in stage I of the disease and are associated with good long term prognosis.
Unfortunately, it is estimated that in time 13% of cases diagnosed with endometrial cancer will develop recurrence, in these cases the mortality rate being up to 25% (4,5). Once the recurrent disease is diagnosed, the main therapeutic options include chemotherapy for distant or widely metastatic recurrence, radiotherapy for small, isolated pelvic recurrences especially if the patient had not been submitted to radiation therapy previously and resection for cases presenting localized centro-pelvic recurrence (6-8). However, most patients experiencing pelvic recurrence within the first three years after the initial diagnosis are diagnosed with vaginal vault relapse, in these cases total colpectomy or even pelvic exenteration being required (7,9,10).

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Cytoreductive Surgery for Peritoneal Carcinomatosis from Endometrial Cancer - A Case Report and Literature Review

Endometrial cancer is one of the most common malignancies of the genital tract in women, with an increasing incidence in the last few years. The reported incidence in the United States surpassed 40.00 cases/year while the death rate reached almost 7500 deaths/year (1,2). The most important prognostic factors are thought to be diabetes, estrogen secreting tumors, nulliparity and the higher number of overweight persons (2). While up to 70% of patients are diagnosed in an early stage of the disease and report an excellent outcome (5 year overall survival of 90%), patients diagnosed in an advanced stage of the disease have a poor prognosis associated with low rates of survival - 67% and 23%, respectively, for cases with regional or distant disease (3). However, in these cases it seems that an aggressive surgical approach similar to the one performed in advanced ovarian cancer is perfectly justified (2,4).

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Total Pelvic Exenteration for Locally Invasive Cervical Cancer with Vesico-Vaginal Fistula

Cervical cancer still represents an important health problem, many cases still being diagnosed in an advanced stage of disease with already existing invasion of the surrounding viscera. (1,2) The presence of a locally invasive cervical tumor with aggressive surgical behaviour can produce local tumoral invasion which sometimes is associated with continuity solutions between different organs. When it comes to cervical cancer, the viscera most frequently affected by the formation of these fistulas are rectum and urinary bladder. (3,4) We present the case of a 49 year old patient diagnosed with stage IVA cervical cancer in whom a total supralevator exenteration was performed.

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POSTERIOR PELVIC EXENTERATION FOR ADVANCED, UNRESPONSIVE TO RADIATION THERAPY CERVICAL CANCER - A CASE REPORT

Although pelvic exenterations represent aggressive surgical procedures which might associate physical and psychological problems and a worsened body image, they are the only potential solution with curative intent in centro-pelvic tumors originating from both digestive and gynecologic tract. (1,2,3) In selected cases preoperative oncologic treatment can offer a tumor down-staging or can diminish the tumoral invasion in adjacent organs providing this way the possibility of less aggressive surgical procedures. In other cases this desiderate cannot be obtained
the tumor proves to be unresponsive to neo-adjuvant treatment and multivisceral resections being needed in order to obtain a good control of the disease. Studies have shown that clinical features of the tumor and both molecular and non-molecular biomarkers can be responsible for the poor tumoral response at irradiation. (4) In these cases surgery remains the only treatment with curative intent. We present the case of a 62 year old patient diagnosed with a large cervical tumor in which neo-adjuvant treatment failed to obtain an acceptable control of the disease. She was addressed to our service after augmentation of the tumor under neo-adjuvant treatment
we performed a total hysterectomy en bloc with bilateral adnexectomy, total colpectomy, abdomino-perineal rectal resection and pelvic lymph node dissection with good results.

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Para-Aortic Lymphadenectomy Associated with Excision of Liver Lesions in Advanced-Stage Cervical Cancer - A Case Report

Cervical cancer represents a major health problem, ranking worldwide as the second most frequent malignancy in women (1,2). Although screening tests for cervical cancer are widely utilized, there is still a large number of patients who are diagnosed in an advanced stage of the disease (3). The main patterns of tumoral spread involve mainly parametria, upper vagina, uterus and pelvic lymph nodes (4,5). The incidence of positive lymph nodes increases proportionally with FIGO stage: pelvic lymph node metastases range between 12% in stage Ib up to 43% in stage IIb (4). Metastases to the aortic lymph nodes are secondary to the pelvic ones, the risk of positive para-aortic lymph nodes rising up to 30 %
on the other hand, skip metastases to aortic nodes represents a very rare condition (6-10). Extended para-aortic lymph node dissection provides an appropriate debulking surgery, allows an adequate histological evaluation and disease staging and offers important information in order to plan the extension of postoperative radiation field (7-15).

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