Laparoscopic pelvic exenteration for malignant tumors of the female reproductive system: a case series

Abstract

Background. Surgical treatment of locally advanced and recurrent malignant neoplasms of the female reproductive system is a difficult task requiring extensive multivisceral resections and exenteration. Minimally invasive access allows for less traumatic intervention and improved visualization, potentially leading to improved oncologic outcomes and fewer complications. Aim. To evaluate intraoperative and early postoperative results of laparoscopic pelvic exenterations. Materials and methods. 12 laparoscopic pelvic exenteration were performed between December 2022 and September 2023. Strict selection of patients for laparoscopic access was not performed. Local recurrence was noted in 8 patients, in 3 cases there was continued growth after chemoradiotherapy. 8 patients had a history of pelvic irradiation. 9 women had received drug therapy in the past. Results. Total exenteration was performed in 5 patients, anterior exenteration in 5 patients, and posterior exenteration in 2 patients. The average duration of the operation was 420.8±99.2 (300–625) minutes, the average volume of blood loss was 166.7±98.5 (100–400) ml. Significant postoperative complications (Clavien–Dindo grade III) were registered in two cases: pelvic abscess that required relaparoscopy and sanation, as well as intra-abdominal abscess – drained under ultrasound control. In one case on the 18th day after the surgical intervention a fatal outcome (Clavien–Dindo grade V) due to pulmonary embolism was registered. The median postoperative bed-day was 14.5 (8–32) days. Conclusion. Laparoscopic access for pelvic exenteration improves intraoperative and early postoperative results. It is necessary to further improve the techniques of this intervention and to define clear indications for its performance, which will allow to achieve better treatment results.