外科ジャーナル

Decisional Algorithms for the Reconstruction of Pelviperineal Defects After Total Pelvic Exenteration: A Review

Abstract

Dan Cristian Moraru* and Viorel Scripcariu

Abdominoperineal resection remains the “gold standard” for cancers of the lower rectum and of the anal canal as a result of the failure of the primary conservative care. Total pelvic exenteration leaves an important pelviperineal defect which requires reconstruction techniques to be applied when primary closure cannot be performed.

Pelvic floor reconstruction is required and various complications, especially infectious, may occur in this area. The pelvis can be reconstructed using flaps. The perineal reconstruction that uses the numerous perforator flaps described lately raises the following question: which flap should be chosen?

Each flap and its variants have their own advantages and disadvantages, and the choice of the appropriate reconstructive technique involves a collaboration between the gastrointestinal oncology surgeon, the radiologist, the anaesthesiologist and the plastic surgeon in order to identify when and which surgical reconstruction is to be preferred, using reconstruction algorithms to choose the appropriate technique. Various studies are presented describing the experience of one or more centers regarding reconstruction options and the decisional tree adopted in the form of an algorithm both in relation to neoadjuvant irradiation therapy and without irradiation.