Urinary reconstruction following total pelvic exenteration for locally advanced rectal cancer: complications and factors affecting outcomes

Introduction Total pelvic exenteration (TPE) for rectal cancers is associated with significant morbidity. We evaluated the complications related to urinary reconstruction following TPE and factors predicting urologic morbidity. Methods Retrospective analysis of TPE patients with incontinent urinary...

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Bibliographic Details
Published in:Langenbeck's archives of surgery 2021-03, Vol.406 (2), p.329-337
Main Authors: Kazi, Mufaddal, Rohila, Jitender, Kumar, Naveena AN, Bankar, Sanket, Engineer, Reena, Desouza, Ashwin, Saklani, Avanish
Format: Article
Language:English
Subjects:
Abdominal Surgery
Cardiac Surgery
General Surgery
Medicine
Medicine & Public Health
Original Article
Thoracic Surgery
Traumatic Surgery
Vascular Surgery
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Summary:Introduction Total pelvic exenteration (TPE) for rectal cancers is associated with significant morbidity. We evaluated the complications related to urinary reconstruction following TPE and factors predicting urologic morbidity. Methods Retrospective analysis of TPE patients with incontinent urinary diversions between August 2013 and January 2020. Results One hundred TPE were performed with 96 ileal conduits (IC). Early complications occurred in 10 patients that included uretero-ileal leaks (5%), conduit-related complications (3%), and acute pyelonephritis (3%). Late complications were seen in 26% of patients with uretero-intestinal strictures in 11%. Mortality attributable to urinary complications was seen in 2%. No single factor, including prior radiation, recurrent disease, type of anastomosis, or blood loss, predicted development of urinary morbidity. Conclusion Conduit urinary diversion following TPE is associated with high urinary morbidity rate but low mortality. It can be safely performed even after previous surgeries and radiation by a dedicated colorectal team.
ISSN:1435-2443
1435-2451
DOI:10.1007/s00423-021-02086-z