ABSTRACT
Laterally extended endopelvic resection (LEER) is usually combined with a therapeutic pelvic and peri-aortic lymph node dissection unless this treatment for regional tumor control has been performed with previous surgery. For reconstruction or substitution of the pelvic functions lost due to LEER, a broad spectrum of procedures has to be available comprising ileum and transverse colon conduits, ileum neobladder, ileocecal and transverse colon pouches, rectal J-pouches, colorectal anastomosis or colostomy, rectus abdominis musculocutaneous flaps, and sigmoid colon neovagina. Therapeutic angiogenesis of the denuded and mostly irradiated pelvis, preferably by an omentum majus flap, is essential. In abdominoperineal LEER procedures, vulvovaginal and perineal reconstruction is accomplished with fasciocutaneous and musculocutaneous flaps, such as pudendal thigh flaps, gracilis flaps, and gluteal thigh flaps. General principles include using no irradiated tissue for reconstruction and setting safety over comfort in all situations of potential surgical compromise. Secondary healing is used as a primary surgical strategy in situations where therapeutic angiogenesis is not applicable.
