Low Colorectal Anastomosis After Pelvic Exenteration for Gynecologic Malignancies: Risk Factors Analysis for Leakage

Abstract

Objective:To study risk factors for low colorectal anastomotic leak after pelvic exenteration for gynecologic malignancies.Methods:Data from 60 patients, 32 with ovarian cancer and 28 with nonovarian cancer who underwent pelvic exenteration with colorectal anastomosis (CRA) were retrospectively analyzed.Results:Overall rate of CRA leak was 20%. The CRA leak was associated with type of tumor (3% for the ovarian cancer and 40.8% for the nonovarian cancer, P = 0.004), CRA height (<5 cm vs ≥5 cm, 75% vs 6.3%; P = 0.001), and previous radiotherapy (RT; 53.3% vs 8.9%; P = 0.001). Multivariate analysis showed that only previous RT and CRA height were associated with the CRA leak. Rectosigmoid wall involvement (81.8% vs 27%; P = 0.001) and mesorectum infiltration (69.2% vs 21.7%; P = 0.001) were more frequent among patients with ovarian cancer patients.Conclusion:Previous RT and CRA at or less than 5 cm from the anal verge pose a high risk for CRA leak. In these cases, a definitive colostomy should be recommended.

Morbidity After Pelvic Exenteration for Gynecological Malignancies: A Retrospective Multicentric Study of 230 Patients

“…Some authors reported increased rate of morbidity in previously irradiated patients and reduced the amount of reconstructions in these patients. 10 In our series, we observed an overall major complication rate of 61% for the cohort with previous radiation treatment versus 33.5% for the entire cohort. This difference was not statistically significant probably because of the relative small numbers of complications, but the trend clearly shows an increased risk in previously irradiated patients.…”

Modified posterior pelvic exenteration for advanced ovarian malignancies: a single-institution study of 35 cases

“…An unacceptable level of risk is observed when the colorectal anastomosis is set up at or under 5 cm from the anal verge. In these cases, a definitive colostomy should be recommended .…”

Utility of closed suction pelvic drains at time of large bowel resection for ovarian cancer

“…In cases of very low anterior resection (anastomosis within 6cm from the anal verge) the data suggest a potential benefit to drainage [16, 23, 28, 32]. Peeters et al concluded that pelvic drains may offer an earlier detection of AL [13] and Tsujinaka et al [36] suggested drains may help reduce the severity of consequences following an AL in colorectal surgery.…”

“…Significant improvements in outcome have been achieved by focusing on the refinement of surgical techniques and perioperative care. However, growing evidence from the colorectal [1, 28–30] and the gynecologic oncology literature [13, 31–33] supports adaption of fast-track surgery to further enhance postoperative recovery and reduce morbidity. Such an approach warrants evaluating the utility of drains at time of LBR in OC.…”