Pelvic Surgery

The present issue of the International Journal of Surgical Oncology on Pelvic Surgery contains a series of articles on prostate cancer, gynecologic malignancies, and rectal cancer. The article on " radical prostatectomy as a first-line treatment in patients with initial PSA >20 ng/mL " by Hinev et al. reports on patients diagnosed with prostate cancer (PCa) and PSA >20 ng/mL. The elevated PSA level is considered an adverse prognostic factor in PCa often regarded as contraindication to radical surgery. The authors purported to estimate the impact of radical prostatectomy (RP) on biochemical-recurrence-(BCR-) free and cancer specific survival (CSS) for these patients. Men in this group had significantly lower 10-year BCR-free and CSS rates than patients with initial PSA <20 ng/mL (20.7% versus 79.6%/P < 0.001/and 65% versus 87.9%/P = 0.01, resp.). Pathological stages were found to be independent predictors of PSA failure in men with PSA >20 ng/mL. Patients with favorable prognostic variables (pT2, NO) had significantly longer disease-free and overall survival similar to those with initial PSA <20 ng/mL. High PSA values do not indicate poor prognosis uniformly and therefore along with patients with organ-confined PCa and negative lymph nodes may benefit from RP. In one series more than 50% of patients with initial PSA values above 20 ng/mL had undetectable PSA values over the first 5-years after RP. Similar results have been reported in other series with RP used as monotherapy. Neoadjuvant hormonal therapy is no longer recommended for patients subjected to radical surgical treatment. The authors suggest further studies in patients with initial PSA values >20 ng/mL and use of RP in order to verify the results of their study. The article " Total pelvic exenteration (PE) for gyneco-logical malignancies " by Diver et al. describes PE as the en-bloc resection of pelvic organs including reproductive structures , bladder, and rectosigmoid. It is commonly indicated for advanced primary or locally recurrent cancer without evidence of metastatic disease or elements which preclude resection. Major complications occur in as many as 50% of the patients. In carefully selected patients with gynecologic cancer PE can be curative. Separate stomata for urine and fecal diversion and the use of omentum to protect and cover the denuded surfaces and more recently development of techniques to remove involved pelvic side wall have increased the chance of curative surgery. Laparoscopic and robotic-assisted technology has improved operative recovery while a 5-year survival rate of about …