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Key content Exenterative procedures for recurrent gynaecological cancers are uncommon and present clinical challenges. A multidisciplinary approach is key to optimising patient outcome., Surgery is undertaken in almost all cases with curative intent, and rarely with palliative intent., Only complete histological clearance of disease (R0 resection) is associated with long-term survival, but not in all cases., There is an absence of level 1 evidence and national guidelines., Learning objectives Understand the factors that are important in case selection., Appreciate that case selection is individualised and surgery is associated with a high morbidity and mortality rates., Understand the two components of exenterative surgery: (1) complete resection of the cancer (R0) and (2) reconstruction/restoration of pelvic functions., Most exenterations are performed for recurrent disease involving the central pelvis., Recently, radical surgery has been undertaken with favourable outcomes for pelvic sidewall disease., Ethical issues There is a paucity of data on quality-of-life assessment in patients undergoing exenterative surgery for recurrent gynaecological cancers., Prolonged survival may not translate into improved or acceptable quality of life., Following success from the centralisation of cancer services, consideration needs to be given to commissioning exenterative procedures in fewer centres in the UK. [ABSTRACT FROM AUTHOR]

Key content: Bowel obstruction in gynaecological cancers requires a multidisciplinary approach to optimise patient outcomes.Surgery is usually performed with palliative intent. The palliative care team should be involved in patient management especially in the case of recurrent disease.There is no level 1 evidence or national guidance available. Learning objectives: To understand that bowel obstruction in women with gynaecological cancer is rare and seen more often with recurrent disease than primary disease.To appreciate that case selection for surgery is individualised, and that surgery is associated with higher morbidity and mortality rates in emergency cases and following radiotherapy or recent chemotherapy.Most women with gynaecological cancer present with non‐acute bowel obstruction, which is most commonly associated with recurrent epithelial ovarian cancer among gynaecological cancers. Bowel obstruction in irradiated women is less often caused by recurrent cancer.Conservative management includes drug treatments such as opiates, anticholinergics and steroids. Ethical issues: Data on the quality of life of women with gynaecological cancer and bowel obstruction are lacking.Although the goal is palliation in most women, there is no clear definition of ‘successful palliation’.Surgical intervention does not always provide sustained palliation, yet it can contribute to increased morbidity and mortality. [ABSTRACT FROM AUTHOR]

To report on the use of laparostomy after major gynecologic cancer surgery.Operative records and surgical databases of patients who underwent major open abdominal surgery over a 6.5-year period at a tertiary referral center were searched. Patients who had diagnostic procedures, operative laparoscopy, and surgery for vulval cancer were excluded. All patients who had laparostomy were identified; and the diagnosis, indication for laparostomy, method of temporary cover, and complications were recorded.A total of 1592 laparotomies, including 37 emergencies, were performed. Of these, 14 patients (0.88%) had a laparostomy. Seven patients had primary cancer and 7 had recurrent cancer. As more patients had surgery for primary disease, laparostomy was more common in patients who underwent surgery for recurrent cancer. Seven patients had ovarian/fallopian tube/primary peritoneal cancer, 4 patients had uterine cancer, 2 patients had cervical cancer, and one patient had vaginal cancer. Ten laparostomies (71.4%) were performed after an emergency procedure; thus, laparostomy was approximately 100 times more common after emergency than elective major surgery. Massive bowel distension and bowel wall edema were the major indications for laparostomy. The method of temporary closure was variable, and a sterile saline bag was the most commonly used. The laparostomy was closed in all but 2 patients, most often on postoperative day 2 or 3. Two patients (14.3%) died within 30 days of the laparostomy, and 2 others died at postoperative days 40 and 62. Three of these 4 patients had recurrent cancer, and 2 patients had emergency procedures.The overall incidence of laparostomy associated with laparotomy for gynecological cancer surgery was less than 1:100 cases, was more common after surgery for recurrent cancer, and in particular, was approximately 100 times more common after emergency procedures. The 30-day operative mortality rate was 14.3%. [ABSTRACT FROM AUTHOR]

The article discusses a study on the clinical challenges of the surgical management of acute bowel obstruction in gynaecological cancer patients as surgery is associated wit a higher morbidity and mortality rate. Findings suggested that caution is needed when dealing with patients with ascites, short treatment-free interval, acute abdomen and chemoresistance. It concluded that there is a need to identify patients who may or may not benefit from palliative surgical intervention.