Long Term Review of Urological Complications Following Pelvic Exenteration
Author(s):
Mr Michael Bozin
,
Mr Michael Bozin
Affiliations:
Mr Alastair D Lamb
,
Mr Alastair D Lamb
Affiliations:
Mr Rajesh Nair
,
Mr Rajesh Nair
Affiliations:
Mr Nicolas Geurts
,
Mr Nicolas Geurts
Affiliations:
Mr Arun Naik
,
Mr Arun Naik
Affiliations:
Miss Tamara Vu
,
Miss Tamara Vu
Affiliations:
Mr Alastair Simpson
,
Mr Alastair Simpson
Affiliations:
A/Prof Nathan Lawrentschuk
,
A/Prof Nathan Lawrentschuk
Affiliations:
Mr Daniel Moon
,
Mr Daniel Moon
Affiliations:
Mr Jacob McCormick
,
Mr Jacob McCormick
Affiliations:
Mr Satish Warrier
,
Mr Satish Warrier
Affiliations:
A/Prof Craig Lynch
A/Prof Craig Lynch
Affiliations:
BAUS ePoster online library. Lamb A. 06/26/17; 177346; P1-19 Disclosure(s): No disclosures
Dr. Alastair D Lamb
Dr. Alastair D Lamb
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Abstract
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INTRODUCTION AND OBJECTIVE
Pelvic exenteration (PE) is the radical en-block resection of at least two adjacent pelvic organs, including the rectum, genitourinary tract, external genitalia, regional nodes and pelvic side wall. It is the only treatment to offer potential cure for locally advanced/recurrent pelvic cancer.
METHODS
Patients underwent PE at a single quaternary referral centre between Jan 1990 and Aug 2016 with data collected prospectively. Those with en-bloc resection of a genitourinary organ and/or experienced a urological complication as a result of PE were included.
RESULTS
Some 307 patients underwent PE, of which 131 (43%) had a urological component. 75 (57%) were for recurrent and 56 (43%) for primary cancer, mainly rectal. Most underwent neoadjuvant chemotherapy and radiotherapy. Median follow up was 19.5 months (range 0-112), 30-day mortality was 0.76% and overall mortality 41%. LOS was 23.8 days. 106 (80%) underwent radical cystectomy and urinary diversion, with 72 (54%) undergoing concomitant prostatectomy. Six (4%) had partial cystectomy and 18 (14%) ureteric resection. 11 patients (8%) experienced early complications, with the rate of urine leak being 5%. 34 patients (23%) experienced late complications, with the rate of non-malignant ureteric stricture requiring upper tract intervention being 9%. Regarding renal function, 28 (21%) had stage III and IV chronic kidney disease at completion of follow up, five(4%) had loss of function of a single renal unit on nuclear renogram, with two requiring nephrectomy.
CONCLUSIONS
Our 26yr experience with PE demonstrates excellent complication rates. PE is a major surgical endeavour requiring a multidisciplinary approach and should only be performed in centres with appropriate expertise.
INTRODUCTION AND OBJECTIVE
Pelvic exenteration (PE) is the radical en-block resection of at least two adjacent pelvic organs, including the rectum, genitourinary tract, external genitalia, regional nodes and pelvic side wall. It is the only treatment to offer potential cure for locally advanced/recurrent pelvic cancer.
METHODS
Patients underwent PE at a single quaternary referral centre between Jan 1990 and Aug 2016 with data collected prospectively. Those with en-bloc resection of a genitourinary organ and/or experienced a urological complication as a result of PE were included.
RESULTS
Some 307 patients underwent PE, of which 131 (43%) had a urological component. 75 (57%) were for recurrent and 56 (43%) for primary cancer, mainly rectal. Most underwent neoadjuvant chemotherapy and radiotherapy. Median follow up was 19.5 months (range 0-112), 30-day mortality was 0.76% and overall mortality 41%. LOS was 23.8 days. 106 (80%) underwent radical cystectomy and urinary diversion, with 72 (54%) undergoing concomitant prostatectomy. Six (4%) had partial cystectomy and 18 (14%) ureteric resection. 11 patients (8%) experienced early complications, with the rate of urine leak being 5%. 34 patients (23%) experienced late complications, with the rate of non-malignant ureteric stricture requiring upper tract intervention being 9%. Regarding renal function, 28 (21%) had stage III and IV chronic kidney disease at completion of follow up, five(4%) had loss of function of a single renal unit on nuclear renogram, with two requiring nephrectomy.
CONCLUSIONS
Our 26yr experience with PE demonstrates excellent complication rates. PE is a major surgical endeavour requiring a multidisciplinary approach and should only be performed in centres with appropriate expertise.
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