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The management of recurrent pelvic malignancy

The management of recurrent pelvic malignancy. Pete Sagar The General Infirmary at Leeds England. Things could be worse. TWO-timing Shane Warne has been caught cheating with ANOTHER woman. EXCLUSIVE: SHANE'S AT IT AGAIN Cheat Aussie star's two-month affair

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The management of recurrent pelvic malignancy

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  1. The management of recurrent pelvic malignancy Pete Sagar The General Infirmary at Leeds England

  2. Things could be worse

  3. TWO-timing Shane Warne has been caught cheating with ANOTHER woman. EXCLUSIVE: SHANE'S AT IT AGAIN Cheat Aussie star's two-month affair By Megan Lloyd Davies And Richard Smith MESSAGES: Warne sent a string of texts

  4. Presentation • PAIN

  5. The problem • 8-10 000 cases annually of rectal cancer in the UK • Local pelvic recurrence in 5-15%

  6. Treatment – radiotherapy/chemotherapy • Good initial palliation • Long term survivors are rare • Reserved for end stage disease

  7. Treatment- surgery • Multimodality therapy • Team approach essential • Technical demands

  8. Preoperative assessment • Biopsy to confirm diagnosis • CT chest and abdomen • MRI pelvis • EUA • Fitness for operation

  9. The Leeds MDT meeting

  10. Accommodation for relatives

  11. Accommodation for relatives (NHS)

  12. Patterns of pelvic invasion • Localised type • Sacral invasion • Pelvic side wall invasion

  13. Localized type • Recurrent tumour is localized to the adjacent tissues or connective tissue

  14. Peri-anastomotic recurrence

  15. Perineal recurrence

  16. Mucinous adenocarcinoma

  17. Sacral invasion • Recurrent tumour invades the lower sacrum (S3, S4, S5) or coccyx

  18. Chordoma with sacral invasion

  19. Sacral invasion- gadolinium enhanced

  20. Lateral invasion • Recurrent tumour invades pelvic side wall

  21. Pelvic side wall invasion

  22. Vesico-ureteric junction

  23. Planes of attack

  24. APR+S vs TPE+S

  25. Rectus abdominus flap

  26. Anatomical points

  27. When not to operate

  28. Choose your patient!

  29. Contraindications • Extrapelvic disease • Invasion of S1 or S2 • Invasion through greater sciatic notch • Extensive pelvic side wall involvement • ASA IV-V

  30. Para-aortic nodal involvement

  31. Greater sciatic notch involvement

  32. Surgical intervention contraindicated

  33. Extension through both greater sciatic foramina

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