Laterally extended endopelvic resection (LEER)--principles and practice

Area of Science:

• Gynecologic Oncology
• Surgical Oncology
• Pelvic Reconstruction

Background:

• Exenteration is a traditional treatment for advanced pelvic gynecologic cancers.
• Tumors fixed to the pelvic side wall pose significant surgical challenges.
• Improved surgical techniques are needed to increase curative resection rates.

Purpose of the Study:

• To evaluate the efficacy and safety of Laterally Extended Endopelvic Resection (LEER) for advanced gynecologic malignancies.
• To assess the feasibility of LEER in patients with pelvic side wall involvement.
• To determine oncologic outcomes, including survival and recurrence rates, following LEER.

Main Methods:

• LEER combines at least two procedures: total mesorectal excision, total mesometrial resection, or total mesovesical resection.
• The technique involves resection of pelvic side wall muscles and potentially the internal iliac vessel system for extensive tumors.
• One hundred patients with locally advanced or recurrent gynecologic tumors underwent LEER.

Main Results:

• LEER was performed on 100 patients, with 76 having tumors fixed to the pelvic side wall.
• Five-year recurrence-free survival was 62%, and disease-specific overall survival was 55%.
• Moderate to severe morbidity was 70%, primarily related to irradiated tissue healing and complex reconstructions.

Conclusions:

• LEER demonstrates significant potential for salvaging selected patients with advanced or recurrent gynecologic cancers.
• The technique is effective even for tumors fixed to the pelvic side wall, expanding surgical candidacy.
• LEER offers a promising option for challenging cases traditionally deemed unresectable.