Abdominoinguinal incision and other incisions in the resection of pelvic tumors.

摘要

In the past, sarcomas located in the iliac fossa, in the area over the external iliac vessels, or those in the lesser pelvis with fixation to the lateral wall, were inaccessible through the conventional abdominal incisions, mainly due to a lack of distal exposure. They were often called unresectable or were dealt with by an external hemipelvectomy. The abdominoinguinal incision provides exposure in one continuous field of the lower abdomen and the groin area on the side involved by the tumor, or bilaterally, if needed. It provides control of the vessels proximally and distally and easy identification of the femoral nerve lateral to the femoral artery. A simplified version in the form of an L or a reverse T through transection of the ipsilateral/bilateral rectus abdominis off the pubic crest provides a significantly improved exposure for low pelvic tumors in the midline. This affords the opportunity to perform under direct vision dissection in the area of the obturator nodes and obturator foramen, as well as exposure of the distal portion of the external iliac artery and vein. The technique of internal hemipelvectomy and sacral resection for tumors involving any part of the innominate bone or the sacrum, respectively, also amplify the surgical armamentarium in the resection of pelvic tumors with pelvic wall fixation. These incisions, although developed in the management of soft tissue sarcomas of the pelvis, are applicable for other histologic types of cancer when the biology and stage of the tumor are supportive of surgery for the pelvic disease.