Combination of intraperitoneal hyperthermic perfusion chemotherapy (IHPC) with intraperitoneal chemotherapy as a treatment modality for persistent ovarian cancer.

Persistent minimal residual disease diagnosed after the first line of chemotherapy during second-look surgery can be an indication for intraperitoneal chemotherapy. Another treatment option is intraperitoneal hyperthermic perfusion chemotherapy (IHPC) where the drug is administrated into the peritoneal cavity with the use of extracorporeal closed circuit perfusate circulation at a temperature of 41-42 degrees C. We have started to perform, as a second-line treatment, a combination of one IHPC procedure and four cycles of standard intraperitoneal chemotherapy. In a patient who had previously undergone three different chemotherapy regimens, stabilization of the disease was achieved. In our opinion combining the IHPC procedure with intraperitoneal chemotherapy can be valuable in patients with small volume residual tumor.

Management of massive presacral pelvic bleeding in patients with gynecological malignances: review of the literature.

Hemorrhage has always been a significant potential complication in the field of gynecological oncology. Throughout the years, a variety of medical and surgical modalities aimed at controlling pelvic hemorrhage have been developed. Most recently, these have focused on attempting to decrease the morbidity associated with pelvic bleeding. The effectiveness of and the complications involved in controlling massive hemorrhage by the preemptive method of vascular clamping of the aorta, intraoperative methods, such as the local application of procoagulants and of prolonged compression (pelvic gauze packing, plastic wrapped gauze packing, autograft tissue compression and balloon compression) have all been reviewed. Surgeons are able to acquaint themselves with the choice of methods that can be employed during massive pelvic bleeding resulting from procedures on gynecological malignancies.

The role of pelvic exenteration for treatment of pelvic malignancy--a nine-year experience.

Pelvic exenteration offers the last chance for some women with gynecological and rectal malignancy. A series of 23 patients who underwent pelvic exenteration for local advanced gynecological and rectal malignancies between 1996 and 2004 were retrospectively reviewed. The exenteration was performed because of vulvar cancer in 14 patients and other pelvic malignancies in nine cases: rectal cancer in four cases, in three cases cervical cancer, in one case ovarian cancer and in one case uterine sarcoma. Nine patients developed major complications of the operative field involving the urinary tract or the wound. Early complications included massive bleeding from the sacral plexus in two cases (one patient died during surgery), acute respiratory distress syndrome (ARDS) in one case and thrombophlebitis in one case. Urinary incontinence was observed in two women as a late complication. Only one patient had a complication connected with the gastrointestinal tract. Twenty-two patients were followed-up. In the group of patients with vulvar cancer five women died after 4-29 months because of recurrence of disease. The nine surviving patients are still being followed-up and are without disease; survival time ranges from 6-74 months. In the group of patients with other malignancies four women died.

Acute renal failure after anterior pelvic exenteration: a case report and review of the literature.

This is a report of a case of advanced cervical carcinoma in a 34-year-old woman treated with anterior pelvic exenteration at the Department of Gynecology of the Medical University in Gdansk. Despite annual gynecological check-ups, the patient presented with profuse bleeding from the genital tract. IVa cervical carcinoma according to the International Federation of Gynecology and Obstetrics (FIGO) staging was diagnosed. A vesicovaginal fistula was confirmed. In the postoperative period acute renal failure occurred. Twenty-four days after the operation when normal renal parameters had been restored, the patient was transferred to the Department of Radiotherapy for supplementary treatment. Pelvic exenteration offers the last chance for some women with gynecological malignancy and can provide a good chance of long-term survival in carefully selected patients with gynecological cancer.

Surgical pelvic packing as a means of controlling massive intraoperative bleeding during pelvic posterior exenteration--a case report and review of the literature.

This is a report of a case of gynecological hemorrhage after a posterior pelvic exenteration in patients with vulvar cancer treated by temporary pelvic packing at the Department of Gynecology of the Medical University in Gdansk. The packing was successful and the sponges were removed after 24 h. Twenty-eight days after the operation, the patient was transferred to the Department of Radiotherapy for supplementary treatment. In patients with severe intraoperative hemorrhage, intra-abdominal packing has been successful as a mode of treatment.