Behind the knife

Join Professor Michael Solomon, Dr Kilian Brown and Dr Jacob Waller from Royal Prince Alfred Hospital in Sydney, Australia, for this special four part series on pelvic exenteration surgery for locally advanced and recurrent rectal cancer. Learn about these ultra-radical procedures which go beyond the traditional TME planes that we learn during surgical training, and into all compartments of the pelvis.
Episode 4 outlines the complex perineal and soft tissue, urological, bone and vascular reconstructions that may be required as part of these multi-visceral resections, as well as how to approach challenging postoperative complications. Each episode in this series features a different international guest surgeon. In episode 4, the RPA team are joined by A/Prof Gabrielle van Ramshorst from the Ghent University Hospital, Belgium. Technical descriptions: Ho K, Warrier S, Solomon MJ, Lee K. A prepelvic tunnel for the rectus abdominis myocutaneous flap in perineal reconstruction. J Plast Reconstr Aesthet Surg. 2006;59(12):1415-9. doi: 10.1016/j.bjps.2006.01.050. Epub 2006 Jun 22. PMID: 17113532. https://pubmed.ncbi.nlm.nih.gov/17113532/ Jacombs AS, Rome P, Harrison JD, Solomon MJ. Assessment of the selection process for myocutaneous flap repair and surgical complications in pelvic exenteration surgery. Br J Surg. 2013 Mar;100(4):561-7. doi: 10.1002/bjs.9002. Epub 2012 Nov 27. PMID: 23188415. https://pubmed.ncbi.nlm.nih.gov/23188415/ References: Witte DYS, van Ramshorst GH, Lapid O, Bouman MB, Tuynman JB. Flap Reconstruction of Perineal Defects after Pelvic Exenteration: A Systematic Description of Four Choices of Surgical Reconstruction Methods. Plast Reconstr Surg. 2021 Jun 1;147(6):1420-1435. doi: 10.1097/PRS.0000000000007976. PMID: 33973948. https://pubmed.ncbi.nlm.nih.gov/33973948/ van Ramshorst GH, Young JM, Solomon MJ. Complications and Impact on Quality of Life of Vertical Rectus Abdominis Myocutaneous Flaps for Reconstruction in Pelvic Exenteration Surgery. Dis Colon Rectum. 2020 Sep;63(9):1225-1233. doi: 10.1097/DCR.0000000000001632. PMID: 33216493. https://pubmed.ncbi.nlm.nih.gov/33216493/ Sutton PA, Brown KGM, Ebrahimi N, Solomon MJ, Austin KKS, Lee PJ. Long-term surgical complications following pelvic exenteration: Operative management of the empty pelvis syndrome. Colorectal Dis. 2022 Dec;24(12):1491-1497. doi: 10.1111/codi.16238. Epub 2022 Jul 19. PMID: 35766998. https://pubmed.ncbi.nlm.nih.gov/35766998/ Johnson YL, West MA, Gould LE, Drami I, Behrenbruch C, Burns EM, Mirnezami AH, Jenkins JT. Empty pelvis syndrome: a systematic review of reconstruction techniques and their associated complications. Colorectal Dis. 2022 Jan;24(1):16-26. doi: 10.1111/codi.15956. Epub 2021 Oct 25. PMID: 34653292. https://pubmed.ncbi.nlm.nih.gov/34653292/ Persson P, Chong P, Steele CW, Quinn M. Prevention and management of complications in pelvic exenteration. Eur J Surg Oncol. 2022 Nov;48(11):2277-2283. doi: 10.1016/j.ejso.2021.12.470. Epub 2022 Jan 1. PMID: 35101315. https://pubmed.ncbi.nlm.nih.gov/35101315/ Lee P, Tan WJ, Brown KGM, Solomon MJ. Addressing the empty pelvic syndrome following total pelvic exenteration: does mesh reconstruction help? Colorectal Dis. 2019 Mar;21(3):365-369. doi: 10.1111/codi.14523. Epub 2019 Jan 16. PMID: 30548166. https://pubmed.ncbi.nlm.nih.gov/30548166/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.