Should indications for laterally extended endopelvic resection (LEER) exclude patients with sciatica?

Area of Science:

• Surgical oncology
• Minimally invasive surgery
• Gynecologic oncology

Background:

• Laterally extended endopelvic resection (LEER) has traditionally excluded patients with sciatica due to concerns about achieving R0 resection.
• Recurrent cervical cancer, particularly after radiation, presents complex surgical challenges.
• Sciatica can be a debilitating symptom associated with pelvic tumor recurrence.

Observation:

• This study investigated the technical feasibility of laparoscopic LEER in a patient with laterally recurrent, previously irradiated cervical cancer and severe sciatica.
• The recurrent tumor involved extensive pelvic structures, including major blood vessels, bowel, ureter, and the sciatic nerve.
• The surgical approach necessitated complex reconstructive procedures, including femoral bypass and gastrointestinal/urinary tract resection.

Findings:

• Laparoscopic LEER was technically feasible and achieved a pathological R0 resection without immediate postoperative complications.
• The procedure involved a femoral-femoral artery bypass with prosthetic graft interposition.
• Despite successful local control, the patient developed distant metastases and died within one year.

Implications:

• Laparoscopic LEER may be a viable option for managing complex recurrent cervical cancer cases with sciatic nerve involvement.
• Further research with larger patient numbers and extended follow-up is needed to establish definitive indications and assess long-term efficacy.
• This technique highlights the potential of minimally invasive surgery in achieving complete tumor resection in challenging oncologic scenarios.