Pelvik Egzenterasyon
Özet
Pelvik egzenterasyon, kanserden etkilenen kadın üreme organlarının, alt üriner sistemin ve rektosigmoid kolonun bir kısmının en blok rezeksiyonu ile yürütülen radikal bir jinekolojik onkoloji cerrahisidir. Genellikle daha önce radyoterapi almış, nükseden veya ileri evre yaygın santral tutulumu olan jinekolojik kanser hastalarında ümit verici tek küratif tedavi seçeneğidir. Cerrahi kapsamına göre ön, arka veya tam egzenterasyon olarak sınıflandırılır. Son derece radikal olan bu yöntemde hastaların %50’ye yakınında majör komplikasyonlar izlenebilmektedir. Yoğun bakım üniteleri ve cerrahi tekniklerin gelişmesiyle mortalite oranları %23'ten %4-5'e gerilemiştir. Tedavinin planlanmasında biyopsi ile histolojik tanı, uzak metastazların tespiti için PET/BT ve pelvik tümör yükünü değerlendirmek için MR gibi preoperatif görüntüleme tetkikleri kritik rol oynar. Periton metastazı, uzak metastatik lezyonlar ile lumbosakral vertebra (S1 ve üstü) veya siyatik sinir invazyonu operasyon için kesin kontrendikasyon oluşturur. Cerrahi esnasında uzak metastaz saptanması halinde ise işlem sonlandırılır.
Pelvic exenteration is a radical gynecological oncology surgery performed by en bloc resection of the female reproductive organs, lower urinary tract, and part of the rectosigmoid colon affected by cancer. It is generally the only promising curative treatment option for patients with recurrent or advanced widespread central involvement gynecological cancers who have previously received radiotherapy. It is classified as anterior, posterior, or total exenteration depending on the surgical scope. In this highly radical method, major complications can be observed in nearly 50% of the patients. With the development of intensive care units and surgical techniques, mortality rates have decreased from 23% to 4-5%. In treatment planning, preoperative imaging tests such as biopsy for histological diagnosis, PET/CT for detecting distant metastases, and MR to evaluate the pelvic tumor load play a critical role. Peritoneal metastasis, distant metastatic lesions, and invasion of the proximal lumbosacral vertebra (S1 and above) or sciatic nerve constitute absolute contraindications for surgery. If distant metastasis is detected during surgery, the procedure is terminated.
Referanslar
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