Surgical treatment policy for locally advanced small pelvic tumors involving the bladder

As high as 40% of patients have locally advanced pelvic tumors without distant metastases and many of them have previously undergone radical treatment. The only possible treatment for these patients is combined and expanded surgery.

Subjects and methods: In 1996 to 2004, a total of 38 patients with locally advanced pelvic tumors involving the bladder underwent different types of evisceration at the Department of Radiosurgery, Russian Cancer Research Center. There were internal fistulas in 18 cases. Total evisceration was performed in 4 (10.5%) patients, subtotal supralevator evisceration in 25 (65.8%), subtotal infralevator evisceration in 3 (7.9%), and frontal evisceration in 6 (15.8%) patients. Thirty-one (81.6%) patients underwent ureteral reconstruction without ureterostomy; normal stool restored in 35 (92.1%) patients.

Results: One (2.6%) patient died intraoperatively. Twenty-eight patients had postoperative complications that needed resurgery in 12 cases. Three patients with the single-stage ileal orthitopic bladder reported that they had a fair urinary retention. One patient complained about nocturnal urinary incontinence. Stool retention was fair in all cases.

Conclusion: Careful selection of patients, comprehensive preoperative preparation, and improved surgical performance will reduce the incidence of postoperative complications.