STUDY OBJECTIVE:

To study the feasibility, morbidity, and oncologic outcome of laparoscopic posterior exenteration in patients with advanced gynecologic malignant diseases.

DESIGN:

Retrospective study based on clinical experience (Canadian Task Force classification III).

SETTING:

Private hospital.

PATIENTS:

The medical records for 10 patients who underwent laparoscopic posterior exenteration because of advanced gynecologic malignant disease were retrospectively reviewed.

INTERVENTION:

Laparoscopic posterior exenteration involving selective resection of the uterus, ovaries, vagina, and rectum was performed using a 6-port technique that included harmonic shears, the LigaSure device, and a circular endostapling instrument.

MEASUREMENTS AND MAIN RESULTS:

Histopathologic diagnosis included carcinoma of the cervix in 5 patients, ovary in 4 patients, and vagina in 1 patient. Indication for surgery was primary disease in 7 patients and secondary disease in 3 patients. Complications included delayed bladder recovery in 4 patients, and anastomotic leak, wound infection, and prolonged ileus in 1 patient each. No conversions to open surgery were required. The extent of resection was supralevator in 8 patients and infralevator in 2. Median operative time was 210 minutes. Median length of hospital stay was 9 days. Median blood loss was 360 mL. Disease recurred in 1 patient. After a median follow-up of 26 months, 9 patients were alive, and 8 were free of disease.

CONCLUSION:

Laparoscopic posterior exenteration is feasible in advanced gynecologic malignant disease with rectal involvement. In addition to the known benefits of laparoscopic surgery, carefully selected patients could achieve a survival benefit following R0 resection.

Copyright © 2010 AAGL. Published by Elsevier Inc. All rights reserved.