An allied health rehabilitation program for patients following surgery for abdomino-pelvic cancer: a feasibility and pilot clinical study.

PURPOSE: To investigate the feasibility of conducting a rehabilitation program for patients following surgery for abdomino-pelvic cancer. METHODS: A non-randomised controlled before-and-after study. Patients who had undergone surgery for stage I-III abdomino-pelvic cancer (colorectal, gynaecological or prostate cancer) were recruited. The rehabilitation group (n = 84) received an 8-week, bi-weekly education and exercise program conducted by a physiotherapist, exercise physiologist, health psychologist and dietician, supplemented by exercise diaries and telephone coaching sessions. The comparator group (n = 104) completed postal questionnaires only. Feasibility measures, functional exercise capacity, muscle strength, physical activity levels, pelvic floor symptoms, anxiety and depression, health-related quality of life (HRQoL) and self-efficacy were measured at baseline (time 1), immediately post-intervention (time 2) and at 6 months post-baseline (time 3) and compared within- and between-groups. RESULTS: The consent rate to the rehabilitation program was 24%. Eighty-one percent of the rehabilitation group attended 85-100% of 16 scheduled sessions. Overall satisfaction with the program was 96%. Functional exercise capacity, handgrip strength in males, bowel symptoms, physical activity levels, depression and HRQoL were significantly improved in the rehabilitation group (p < 0.05) at time 2. The improvements in all these outcomes were sustained at time 3. The rehabilitation group had significantly improved physical activity levels, depression and HRQoL compared with the comparator group at times 2 and 3 (p < 0.05). CONCLUSION: Recruitment to this oncology rehabilitation program was more difficult than expected; however, attendance and patient satisfaction were high. This program had positive effects on several important clinical outcomes in patients following abdomino-pelvic cancer treatment. TRIAL REGISTRATION: ANZCTR 12614000580673.

OUTCOME OF INTERNAL HEMIPELVECTOMY IN A PATIENT WITH MULTIPLE MYELOMA--CASE REPORT.

A patient treated for thyroid cancer was diagnosed with multiple myeloma in the context of trauma. After the pelvic tumor devascularization she underwent internal hemipelvectomy Type I + IIA Enneking Classification using polymerizing bioneutral gel embolization, "Glubran 2". The purpose of this case report is to demonstrate the importance of careful selection of treatment methods, together with adequate physical therapy in order to obtain favorable long-term results.

Efectos adversos a largo plazo de la fase de llenado vesical en varones tratados con radioterapia pélvica / Long-term adverse effects on bladder filling phase in males submitted to the pelvic radiotherapy

INTRODUCCIÓN: Los efectos adversos de la radioterapia externa RT sobre la función del tracto urinario inferior de los varones están pobremente estudiados. OBJETIVO: Estudiar y cuantificar los efectos a largo plazo sobre la fase de llenado en varones tratados con radioterapia. MÉTODOS: Estudio comparativo retrospectivo de una cohorte de 99 varones tratados con radioterapia externa, realizada con una media de 4,7 años antes del inicio del estudio. Los pacientes estudiados fueron sometidos a radioterapia como tratamiento del cáncer de próstata localizado, tumor de colon y tumor de recto. Se utilizó como grupo control una cohorte de 97 hombres mayores de 50 años que no habían sido sometidos a tratamiento radioterápico. RESULTADOS: La capacidad vesical cistomanométrica y en el momento del primer deseo miccional fueron significativamente menores en el grupo tratado con radioterapia. El análisis univariante mostró una disminución de la acomodación vesical 3,5 veces mayor en el grupo tratado con radioterapia y un aumento del riesgo para desarrollar incontinencia de esfuerzo de 9,3 veces. No se encontraron diferencias en el riesgo de hiperactividad del detrusor. En el análisis multivariante la existencia de antecedentes de cirugía radical pelviana fue un factor de confusión para el desarrollo de incontinencia urinaria de esfuerzo, no siéndolo para la disminución de la acomodación vesical. CONCLUSIONES: El principal efecto adverso que se produce a largo plazo después del tratamiento con radioterapia pélvica es la disminución de la acomodación vesical durante la fase de llenado. El tratamiento con RT adyuvante produce alteraciones urinarias a largo plazo

OBJECTIVE: To describe and quantify the long-term adverse effects on filling phase of lower urinary tract function in males submitted to radiotherapy. METHODS: We performed a retrospective comparative study on a cohort of 99 men undergoing EBRT a mean of 4.7 years before for clinically localized prostate, rectum or colon neoplasia, and another cohort formed by 97 men over 50 years who did not undergo radiotherapy. RESULTS: Cystometric bladder capacity and bladder capacity at first voiding desire were significantly lower in the radiotherapy group. Univariate analysis showed that the radiotherapy group evinced a risk to present a diminished compliance of 3.5 times more and 9.3 times more to find stress urinary incontinence, but we did not found increased risk for detrusor overactivity. In multivariate analysis the history of radical surgery acted as a confounding factor in the risk of stress urinary incontinence, but not to suffer diminished bladder compliance. CONCLUSIONS: The main long-term adverse effect of pelvic radiotherapy on male bladder function during filling is the increased risk of low bladder compliance

Hemipelvectomias: tratamento, avaliação funcional e prognóstica dos tumores pélvicos / Hemipelvectomies: treatment, functional outcome and prognostic of the pelvic tumors

OBJETIVO: Demonstrar a experiência de uma única instituição em hemipelvectomias internas sem reconstrução. Avaliar as cirurgias pélvicas preservadoras e as amputações interílio-abdominais e seu prognóstico. MÉTODOS: 21 pacientes com tumores primitivos pélvicos submetidos à hemipelvectomia com ou sem preservação de membro. Sete foram tratados com hemipelvectomias externas (amputação) e 14 com internas, entre junho de 2004 e julho de 2009. A classificação cirúrgica utilizada foi a de Enneking para tumores pélvicos. O método de avaliação funcional foi o escore de ISOLS/MSTS. RESULTADOS: A sobrevida dos pacientes em dois anos foi de 63,9 por cento. A média de sobrevida do grupo todo foi de 43 meses. A avaliação funcional demonstrou que as hemipelvectomias preservadoras com ressecção do osso inominado obtiveram 12,5 por cento, 62,5 por cento e 25 por cento de resultados ruins, bons e excelentes, respectivamente. Nos casos em que o osso inominado foi preservado, os resultados foram 16,7 por cento e 83,3 por cento bons e excelentes, respectivamente. CONCLUSÕES: A hemipelvectomia é procedimento pouco usual e causador de importante limitação funcional e comorbidades. A alternativa de ressecar a hemipelve sem reconstrução tem demonstrado resultados tão bons quanto a não-reconstrução. Os elevados custos médicos, além das possíveis complicações com uso de enxerto e próteses justificam a técnica empregada neste artigo. Nível de Evidência IV, Estudo de caso-controle.

OBJECTIVE: To describe the experience of one single institution in internal hemipelvectomies without reconstruction and external hemipelvectomies. METHODS: Twenty-one patients with primary tumors of the pelvic region underwent total hemipelvectomy, at Barretos Cancer Hospital, São Paulo, Brazil, between 2004 and July 2009. Of these, seven were treated with external hemipelvectomy (classic) and 14 with internal hemipelvectomy. Evaluation was done based on Enneking's surgical classification for internal hemipelvectomy. RESULTS: Overal survival in two years was 63,9 percent. Median survival of 43 months. Functional outcomes demonstrated that procedures with inominate bone ressection reached 12,5 percent, 62,5 percent and 25 percent of bad, good and excellent results, respectively. When inominate bone was preserved the results were 16,7 percent and 83,3 percent good and excellent, respectively. No endoprosthesis or bone graft reconstructions were done. CONCLUSIONS: Hemipelvectomy is an unusual procedure that is rarely performed because it is infrequently indicated and because of its high morbidity rate. In some reports, the morbidity rate has reached 77 percent of the cases. We did not perform any type of reconstruction or arthrodesis based on complications and the experience of good results with this method. Our results are similar to the main reports and are still subject of discussion by the oncologic surgeons. Level of evidence IV, Case-control study.

Resultado funcional em crianças e adolescentes submetidos à hemipelvectomia interna tipo II, com ou sem reconstrução do anel pélvico / Functional outcome in children and adolescents submitted to type II internal hemipelvectomy with or without reconstruction of the pelvic ring

Objetivo: Avaliar retrospectivamente os resultados funcionais em crianças e adolescentes portadores de tumores pélvicos, submetidos à hemipelvectomia interna tipo II, com ou sem reconstrução do anel pélvico. Métodos: Foram avaliados 31 pacientes portadores de tumor pélvico, tratados no Centro Infantil Boldrini e no Hospital A.C. Camargo, entre 1994 e 2005. O resultado funcional foi baseado no sistema de avaliação funcional padronizado por Enneking et al. Os critérios analisados foram: dor, função, aceitação emocional, necessidade de suporte, capacidade de deambulação e marcha. Dos 31 casos seguidos, 12 (38,7%) fizeram a reconstrução do anel pélvico com enxerto de fíbula e 19 (61,3%) não a fizeram. A média de idade dos pacientes foi de 11,4 anos (4-17,8 anos). A média de seguimento para os 31 casos foi de 41 meses. Resultado: Obtido aos 12 meses do pós-operatório, foi excelente em 17,4% dos pacientes (todos com reconstrução do anel pélvico), bom em 60,9% dos pacientes, regular em 17,4% e ruim em 4,3%. A média do escore foi melhor no grupo de pacientes com a reconstrução com auto-enxerto de fíbula, comparativamente ao grupo dos que não tiveram essa reconstrução, sendo significativa a diferença entre os grupos (p = 0,008). Conclusão: Os pacientes submetidos à hemipelvectomia interna com reconstrução do anel pélvico com auto-enxerto de fíbula tiveram melhor resultado funcional global comparativamente ao grupo dos que não foram submetidos à reconstrução (p = 0,007). Dentre os critérios específicos do sistema de avaliação funcional, os escores obtidos nos itens aceitação emocional (p = 0,001), capacidade de deambulação (p = 0,034) e marcha (p = 0,002) foram melhores nos pacientes com reconstrução, quando comparados com os do grupo sem reconstrução do anel pélvico...

Ewing's sarcoma of the pelvis: combined surgery and radiotherapy treatment.

BACKGROUND AND OBJECTIVES: Local therapy of pelvic Ewing's sarcoma remains a challenge because of the complex anatomy and large tumor volumes. Wide resections often end up contaminated with marginal margins in one part of the specimen. Pelvic tumor surgery causes considerable disability, because of the loss of hip function. This may cause a low quality of life for tumor survivors. The aim of the study was to evaluate the oncologic results of combined surgery and radiotherapy of pelvic Ewing's sarcoma. Functional and psychosocial outcome of the tumor survivors was assessed. METHODS: Thirty-six pelvic Ewing's sarcoma patients were treated surgically for local tumor control between 1986 and 1996. Chemotherapy was administered according to current European Intergroup/Cooperative Ewing's Sarcoma Study (EI/CESS) protocols. Radiotherapy was also performed on all patients. All patients were intended to get wide tumor excision and a limb salvage procedure. Complications necessitating operative revision were analyzed and functional results were scored according to the criteria of the Musculoskeletal Tumor Society (MSTS). Quality of life and psychosocial functioning was assessed by the QLQ-C 30 of the European Organization for Research and Treatment of Cancer (EORTC). RESULTS: The overall 5- and 10-year survival rate was 45%. The prognosis of patients with primary metastases was 33%. There were two local recurrences after marginal resection. Every second patient needed at least one surgical revision. A secondary hindquarter amputation was avoided in all patients. MSTS functional evaluation instruments reached 59% (+/-21.0%). Global quality of life of the QLQ-C 30 showed good results (70 +/- 16%) compared to the general population (75 +/- 24%). CONCLUSIONS: The advantages of surgical local control of pelvic Ewing's sarcoma should be offered to the patient. Quality of life measurement after internal hemipelvectomy shows that the life of these patients is more than worth living and that they are able to compensate the functional impairment.

Two-stage technique for implantation of inflatable penile prosthesis in pelvic cancer surgery.

A two-stage technique for implantation of an inflatable penile prosthesis has been developed for patients undergoing radical pelvic cancer surgery. Over the past five years, this method has been utilized in 147 men undergoing radical cystectomies or prostatectomies. The technique involves implanting the reservoir and pump of the prosthesis at the time of the radical cancer operation when the lateral neurovascular bundles of erection are being sacrificed. The reservoir and pump are permanently connected, and the cylinder tubings from the pump are temporarily connected and placed in the subcutaneous tissue overlying the pubis. During a second procedure, usually six to twelve weeks later, the cylinders are implanted infrapubically and connected to the easily located pump tubing. The advantages are several. (1) The pump and reservoir are easily implanted during the pelvic surgery while importantly not adding significantly to the operative time or morbidity of the primary procedure. (2) The reservoir is easily positioned in the pelvis. (3) The scrotum with its contained pump already will be healed when the entire prosthesis is connected, bypassing the initial scrotal pain and edema. (4) Psychologically the patients feel relieved that their erectile dysfunction is being treated immediately. This two-stage technique appears to maximize the gain of early and easy implantation while minimizing the potential problems of concomitant surgery.

Allografts in orthopedic surgery: a case report and literature review.

Recent advances in orthopedic surgery have reawakened interest in the use of osteochondral allografts. A case is presented of a 32-year-old man who was spared a hemipelvectomy for a huge chondrosarcoma of the pelvis by receiving a massive pelvic allograft. This is apparently the first report of such a procedure being performed in Canada. A history of allografting as well as the fate and immunologic aspects of bone grafts are presented. Bone-banking procedures and the clinical application of allografts in 1986 are discussed.