The document discusses an ultra-radical gynecologic oncology procedure that involves removing the uterus, cervix, tubes, ovaries, and parts of the bladder, rectum, and pelvis in block for certain types of cervical, ovarian, or endometrial cancers. It notes a 50% 5-year survival rate for select patients and describes reconstruction techniques using gracilis myocutaneous flaps, rectus abdominis flaps, and skin grafts. Post-operative care involves removing a mold and changing dressings over several months.

1. Abdulrahim Gari M.D.
Gynecologic Oncologist
gari505@yahoo.ca

2. Ultra-radical Gynecologic oncology procedure includes
en block resection of :
 Uterus/Cx
 Tubes & ovaries
 Cystectomy (with urinary diversion).
 Procto - Sigmoidectomy (with colostomy).

5.  Cx ca with recurrence after irradiation.
 Primary stage IV Cx ca with tumor into the
bladder and rectum but remains confined to
the pelvis .
 Ovarian ca/Endometrial ca ???
 50% 5 yrs survival in well selected patients.

6.  Total exenteration with perineal phase
 Supralevator total exenteration with low rectal
anastomosis

7.  Gracilis Myocutaneous (GM).
 Rectus Abdominis Myocutaneous (RAM).
 Sigmoid Neovagina
 Rectus Abdominis with spilt thickness skin graft
 Omental flap with split thickness skin graft (pouch)

11.  RAM showed lower overall incidence of flap-
specific complications and significantly lower
incidence of flap loss compared with GM flap
Soper et al.
Int J Gynecol Cancer. 2007;17(1):298.
, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine,
Chapel Hill, NC 27599

12.  Rectus Abdominis with spilt thickness skin
graft
 Omental flap with split thickness skin graft
(pouch)

21.  POD # 14 : EUA and removal of the mold.
 POD # 15 : Pelvic MRI (Dynamic).
 Daily mold’s changing and cleaning x 6 M.
 On and off during the following 4M.
 Then at bed time only.

22. Thank you