Total Pelvic Exenteration for Locally Advanced and Recurrent Rectal Cancer: Urological Outcomes and Adverse Events.

Autor: Khan O; Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK., Patsouras D; Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK., Ravindraanandan M; Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK., Abrar MM; Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK., Schizas A; Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK., George M; Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK., Malde S; Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK., Thurairaja R; Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK., Khan MS; Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK., Sahai A; Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK. Electronic address: arun.sahai@gstt.nhs.uk.
Jazyk: angličtina
Zdroj: European urology focus [Eur Urol Focus] 2021 May; Vol. 7 (3), pp. 638-643. Date of Electronic Publication: 2020 Jul 02.
DOI: 10.1016/j.euf.2020.06.008
Abstrakt: Background: Little has been reported on urological complications of total pelvic exenteration (TPE) for locally advanced or recurrent rectal cancer.
Objective: To assess urological reconstructive outcomes and adverse events in this setting.
Design, Setting, and Participants: A total of 104 patients underwent TPE from 2004 to 2016 in this single-centre, retrospective study. Electronic and paper records were evaluated for data extraction. Mean follow-up was 36.5 mo.
Intervention: TPE.
Outcome Measurements and Statistical Analysis: Urological complications were analysed using two-tailed t and chi-square tests, binary logistic regression analysis.
Results and Limitations: Sixty-three (61%) patients received radiotherapy prior to TPE. Incontinent diversions included ileal conduit (n = 95), colonic conduits (n = 4), wet colostomy (n = 1), and cutaneous ureterostomy (n = 1). Three patients had a continent diversion. The overall urological complication rate was 54%. According to Clavien-Dindo classification, 30 patients, five patients, and one patient had grade III, IV, and V complications, respectively. The commonest complication was urinary tract infection (in 32 [31%] patients). Anastomotic leaks were seen in 14 (13%) cases, of which eight (8%) were urinary leaks. Fistulas were seen in three (3%) patients, involving the urinary system. A return to theatre was required in 12 (12%) patients. Ureteroenteric strictures were seen in seven (7%). No differences were seen in urological outcomes in patients with primary or recurrent rectal cancer (p = 0.69), or by radiation status (p = 0.24). The main limitation is the retrospective nature of the study.
Conclusions: TPE is complex with recognised high risk of morbidity. In this cohort, there was no significant difference in outcomes between primary and recurrent disease, and surgery after radiation.
Patient Summary: In this study, we assessed urological complications following total pelvic exenteration. Urinary complications affected more than half of patients. Urinary tract infection is the commonest risk. Approximately one-third of patients required surgical, radiological, or endoscopic intervention ± intensive care admission. Radiation prior to the operation did not affect urinary complications.
(Copyright © 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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