Vascular reconstruction with major pelvic and retroperitoneal malignancy resection

Abstract

Treatment of pelvic tumours which involve the aorto-iliac axis forms the basis of this thesis and is centred around the experience of the pelvic exenteration unit at Royal Prince Alfred Hospital, Sydney, Australia. Here we aim to report the evolution of vascular reconstruction with major pelvic and retroperitoneal malignancy resection and report the outcomes from the largest reported case series to date. In Chapter one, a historical perspective is presented over the 20th and 21st centuries to provide a background into this niche field. Chapter two reviews the entire literature on major vascular resection and reconstruction for advanced pelvic tumours, including preoperative evaluation, techniques used, and outcomes. The largest reported case series in Chapter three audits a single centre’s experience on 50 consecutive patients undergoing major iliac vessel resection aimed to determine whether the R0 resection rate improved with a routine, more radical approach, and whether survival was comparable to reported rates for more central exenterations. Based on current literature and personal experience from the authors’ unit, Chapter four suggests a recommended approach to the management of advanced pelvic tumours involving the aortoiliac axis.