Search

Objective: To compare the immediate results of extended pelvic surgery before and after introduction of standardized fast track surgery (FTS) protocol into routine clinical practice., Material and Methods: The study included 111 patients with pelvic tumors who underwent extended pelvic surgery. The control group included 59 patients whose perioperative management implied traditional approaches (2018-2019), the main group - 52 patients with FTS protocol (2020-2021). Age, BMI and ECOG status were similar. In the main group, females (90.4% vs. 74.6%; p =0.046), patients with recurrent (46.2% vs. 22.0%; p =0.009) and complicated tumors (26.9% vs. 11.9%; p =0.054) prevailed. Obstructive resection without anastomosis was less common in the main group (28.8% vs. 47.5%; p =0.068)., Results: Surgery time was higher (319±125 min vs. 236±79 min, p <0.001) in the main group, but blood loss (238±154 ml vs. 282±150 ml, p =0.029) and incidence of blood transfusions (23.1% vs. 42.4%, p =0.043) were lower. Moreover, complications (36.6% vs. 54.3%; p =0.086), mild complications (Clavien-Dindo class I-II) (11.6% vs. 28.8%; p =0.034) and local infectious complications (19.2% vs. 42.4%; p =0.009) were less common in the main group. Two patients died in the control group due to sepsis following colonic anastomosis and bladder suture failure, respectively. Postoperative hospital-stay was similar (14±9.1 days vs. 14.4±9 days; p =0.89)., Conclusion: FTS protocol is possible and safe in patients with locally advanced and recurrent malignant pelvic tumors. This approach reduces blood loss, the number of blood transfusions and risk of postoperative infections.

Objective: To perfect and estimate the possibilities of using a mini-invasive diagnostic procedure under magnetic resonance (MR) guidance in the complex anatomic situations in cases of pathological small pelvic changes of unknown origin., Material and Methods: Ten small pelvic interventions were made under MR guidance. The indications for bone biopsy under MR guidance were poor visualization of bone changes or their absence during radiography, including computed tomography. Small pelvic organ and soft tissue biopsies were carried out in the situations of complex location of pathological changes adjacent to critical organs, large vascular and neural structures. All interventions were done using a high-field MR scanner. Freehand biopsy was performed in a stepwise fashion under axial and sagittal T2-weighted image control., Results: Informative histological material was obtained in 100% of cases. No complications were observed., Conclusions: It became possible to verify the diagnosis based on morphological findings and to timely determine management tactics only by target biopsy under MR guidance in these 10 patients with small pelvic changes of unknown origin.

The report describes the clinical and morphological characteristics of inflammatory fibrosarcoma (6). Tumor occurred in the mediastinum, small pelvis and liver in patients aged 12-64 yrs. It featured infiltrative growth. Primary tumor relapsed in 2 cases, distant metastases - 4. Four patients died from tumor progression within 7-14 months after diagnosis. Tumors consisted of neoplastic fibroblasts and lymphofibroblasts with polymorphous nuclei and high mitotic activity.

The experience of the computed tomography (CT) application in the pelvic bones and sacrum tumors diagnosis in 46 patients was summarized. The data obtained were defined more precisely using magnet-resonance tomography (MRT). MRT in contradistinction to permits to differentiate the soft tissues and reveal the tumoral invasion of dura mater and the spinal cord substance, the spinal cord nerves affection. Using CT it is possible to estimate more accurately the bone structure and tumoral elements, containing calcium.

Using X-ray computer tomography and magnet-resonance tomography 656 patients with various volumetric formation in pelvic cavity were examined. In 14 (2.1%) of patients nontumoral disease, simulating the neoplasm presence in a small pelvis cavity, was revealed.

An analysis is presented of the data on 330 patients with extraorganic neoplasms of the small pelvis (ENSP), 110 of whom are children, 105 subjects had benign neoplasms, 225 presented with malignant neoplasia. ENSP are manifested primarily by pains in the pelvis and disturbances in physiological functions due to the adjacent organs and structures being squeezed. In applying for medical advice for the first time diagnostic procedures fail to show ENSP in each third (34.2%) patient. The diagnosis of ENSP is supposed to include several studies and it is multi-stage. The most valuable information concerning ENSP is provided by rectal and/or vaginal examination of pelvic cavity. A scheme was elaborated for establishing boundaries of the focus, determining the size of a neoplasm, as was the classification according to the stages and TNM system for the objective information to be obtained on localization, size and distribution of a neoplasm. Employed in the evaluation of patients were rectoscopy (in 158 patients), cystoscopy (123), roentgenography of bones and pelvic cavity (306), pelvic pneumography (79), excretory urography (175), rectosigmoidography (178), ultrasonography (102), computerized tomography (118), angiography (112) and other procedures, all these having been done in order to be able to make as accurate and precise a diagnosis as possible.

For the 1967-1989 period of 330 patients with nonorganic small pelvis cavity tumors in 93 (28.3%) the neurogenic neoplasms were diagnosed, including 45-nonmalignant and 48-malignant. At initial admission in 30.1% observations the diagnostical mistakes were committed due to low oncological watchfulness of general profile physicians and the finger rectal examination neglect. Clinical examination of the patients was the main source of information about neurogenic neoplasms. The use of special examination methods is obligatory for the tumor spreading detection.

The objective technique for determination of the depth of location of the lower and upper poles of a non-organic mass in the small pelvic cavity, irrespective of sex and age of a patient, has been developed. The correct determination of a mass location permits to choose an optimal surgical approach, increase the operability rate of the tumors and reduce the incidence of complications.

In 1967-1989, 330 patients with non-visceral tumors of the small pelvis (children--110 and adults--220) were registered. One hundred and five patients, 17 children included, presented with benign tumors whereas 225 (children--93 and adults--132)--with cancer. Absolute and relative, local and general contraindications to surgery were outlined. The most important criteria are the extent of tumor, patient's status, equipment and surgical skills. Tumors were approached through 9 different accesses depending on their size and site. Surgery wat performed in 242 patients, viz. 89.5% of patients with benign tumors and 65.7% of those with cancer. The percentage of operated children (37.6%) was much lower than that of adults (85.6%) since the former presented with more advanced tumors. Radical surgery was performed in 192 (79.3%) patients; benign tumors were removed in 86.7% whereas cancer--in 44.9%. Complications were encountered in 56.2% of cases, bleeding being the most frequent one (47.0%). Lethality following radical surgery was 3.1%. Radiation and chemotherapy alone proved ineffective. Complex treatment assured better clinical course. One-ten-year survival rate in adults with malignant tumors was 51.2%-31.8%. As few as 17.2% of children survived one year whereas only 6.5%-2 years which points to more aggressive clinical course of malignant non-visceral tumors of the small pelvis in children.

Fine-needle puncture aspiration biopsy was performed in 182 patients with various visceral tumors. The results were negative in 4 (2.2%) cases only. The malignant nature of tumor was established in 140 cases whereas benign--in 38. The histogenetic type of tumor was reliably established in 75% of patients. In 25% of cases, biopsy revealed a malignancy but failed to identify its origin.

The paper discusses the results of examination of 205 cases of extra-organ tumors of the small pelvis carried out in 1967-1986. The study group included 65 pediatric and 140 adult patients, 57 (28%) males and 148 (72%) females, 194 primary and 11 relapsing cases. Patients aged under 4 years (47, i. e. 23%) prevailed. Benign tumors were detected in 83 (40.5%) and malignant ones--in 122 (59.5%) cases. Disease was asymptomatic in 39 (19.0%) patients and presented with multiple symptoms in 166 (81.0%). Rectally, the upper pole of lesion was palpable in 47 (22.9%) while the lower one--in all cases. Tumors which took up as much as two-thirds of the small pelvis cavity were found in 37 (56.9%) pediatric and 31 (22.1%) adult patients. Tumorous or secondary lesions of adjacent organs were detected rectoscopically in 47 of 74 (63.5%) cases: sensitivity (s)-88.6%, specificity (sp)-57.1%; using chromocystoscopy--in 43 of 64 (67.2%): s-89.5%, sp-75.0%; pelvic pneumography-31 of 56 (55.3%): s-68.8%, sp-54.5%; excretory urography-53 of 79 (67.0%): s-88.3%, sp-68.4%; irrigoscopy-55 of 79 (69.6%): s-82.4%, sp-75.0%; angiography-30 of 70 (42.8%): s-90.9%, sp-78.4% and computer tomography--in 42 of 45 (93.3%) patients: s-96.4%, sp-88.2%. Four stages of diagnosis were suggested.

On the basis of the experience of the vascular surgery department of the A.V. Vishnevsky Surgery Institute the author explains some difficulties in the diagnostics of the primary extra-peritoneal pelvis tumours.

Analysis was made of 13201 ultrasonic studies (USS) of abdominal and small pelvic organs in 5500 patients admitted to the therapeutic department of the multiple-discipline hospital to identify sizable injuries. As many as 176 sizable injuries to the liver, kidneys, gallbladder, pancreas, retroperitoneal space and other organs were recognized. Of these, 52 injuries appeared malignant. Fifty-eight sizable injuries including 12 malignant ones had been diagnosed at the preclinical stage. The prophylactic USS of the abdominal cavity should as minimum include USS of the liver and kidneys with adjacent tissues. The USS of the pancreas should be carried out provided the patient is suspected of having an organ injury. The internal sex organs of the women, the prostate and urinary bladder should be examined if indicated by proper specialists.

The results of examination and treatment of 100 children with the extraorganic neoplasms of the small pelvis were analysed. Benign tumours were revealed in 14, malignant--in 86 patients. Teratoblastoma was diagnosed in 40 children. The main symptoms of the impaired defecation and urination were noted in 70 patients. The conservative treatment was performed in 57 children. The results of chemoradiotherapy have proved to be unsatisfactory. The operations were performed in 43 patients, of them radical--in 37. The 3-year survival of the patients was 18.2%, 5-year--12.5%.

The authors' findings on 16 cases of small pelvis nonorganic tumor recurrence are presented and relevant recommendations on diagnosis and treatment are given.