Complications and survival after total pelvic exenteration

Abstract

Background: Pelvic exenteration is a procedure with high morbidity despite careful patient selection. This study investigates potential associations between perioperative markers and major postoperative complications including survival. Methods: Retrospectively collected data for 195 consecutive patients who underwent total pelvic exenteration (January 2015eFebruary 2020) at a single tertiary university hospital were analyzed. Results: The 30-day mortality was 0.5%, and the rate of major postoperative complications (3 Clavien-Dindo) was 34.5%. Low albumin level (p ¼ 0.02) and blood transfusion (p ¼ 0.02) were significantly correlated with a major postoperative complication in univariate analyses. This had no impact on survival. Positive margins (p ¼ 0.003), liver metastasis (p ¼ 0.001) were related to poor survival in multivariate analyses for colorectal patients. A Charlson Comorbidity Index >6 (p < 0.05) was associated with poor survival in all patients. Conclusion: The occurrence of major postoperative complication does not negatively impact the overall survival. Pelvic exenteration is a potential life-prolonging operation when negative margins can be obtained, despite known risks for complications. Comorbidity is a predictor for inferior outcomes.

External Small Intestine Fistula as a Rare Complication of Total Infralevatory Pelvic Evisceration

“…Most often, the postoperative period after TPE is complicated by the occurrence of a pelvic abscess (6.1 to 12.8%), failure of ureteroejunoanastomosis with the formation of urinary fistulas (4.6%), while cases of failure of small intestine anastomosis or perforation of the small intestine are less common (3.6%) (Platt et al, 2018;Yang et al, 2021;Nielsen et al, 2022;Shine et al, 2022).…”

“…According to the literature, the failure of sutures on the small intestine during the formation of a small intestine conduit for urination with the appearance of small intestine fistulas occurs in 2.6 to 3% (Nielsen et al, 2022). Berman et al published for the first time a 17-year history in the treatment of patients with small intestine fistulas after TPE and the incidence of the postoperative intestine fistula was 3.5% (Berman et al, 1976).…”

“…Further postoperative management of patients with the presence of a small intestine fistula is not an easy task, and the mortality rate for this complication after TPE reaches 34.4% (Nielsen et al, 2022).…”

Using Bakri balloon as a visceral replacement for occupying pelvic cavity in pelvic exenteration, a case report

“…TPE is a safe procedure with a roughly 0.5–2 % mortality rate [7] . Nevertheless, the morbidity rate rises up to 51 %.…”

Minimally invasive surgery for maximally invasive tumors–pelvic exenterations for rectal cancers: are we prepared?

“…Pelvic exenteration has demonstrated no difference in survival for primary and relapse rectal cancer; however, survival was significantly influenced by margin status, adjuvant chemotherapy, positive lymph nodes, and liver metastasis [ 3 ]. Substantial case reports demonstrating feasibility of the adoption of minimally invasive approach in treating patients with locally advanced rectal cancer requiring pelvic exenterations in patients with primary [ 4 ] or recurrence after initial radical surgery [ 5 ].…”