Urinary diversion after total pelvic exenteration for rectal cancer Journal Article
| Authors: | Russo, P.; Ravindran, B.; Katz, J.; Paty, P.; Guillem, J.; Cohen, A. M. |
| Article Title: | Urinary diversion after total pelvic exenteration for rectal cancer |
| Abstract: | Background: Total cystectomy is indicated for the treatment of bulky primary rectal cancers as well as previously treated, locally recurrent tumors that invade the bladder, prostate, seminal vesicle, or urethra. We review a 10-year Memorial Sloan-Kettering Cancer Center experience with urinary diversion in this setting. Methods: Between April 1988 and June 1998, 47 patients underwent urinary diversion during a total pelvic exenteration for rectal cancer. Charts and operative records were reviewed to determine pathological findings, short-term and long-term urological complications, and survival. Results: Forty-seven patients (25 males and 22 females; median age, 62 years; age range, 27-79 years) were included. Sixteen (34%) patients underwent cystectomy for a primary rectal tumor (including 1 for rectal sarcoma and 1 for synchronous invasive bladder cancer), and 31 (66%) patients underwent surgery for a locally recurrent rectal cancer. Thirty (64%) patients underwent preoperative, 18 (38%) underwent intraoperative, and 11 (23%) underwent postoperative radiotherapy. Twenty-six (55%) patients received preoperative and 16 (34%) underwent postoperative chemotherapy. Two patients had continent ileal cecal reservoirs, 1 a colonic conduit, and the remaining 45 had ileal conduits. The tumor invaded the bladder in 24 (51%) patients, the prostate in 5 (11%) patients, and the seminal vesicle in 5 (11%) patients. Complete resection was achieved in 42 (89%) patients. There were a total of eight complications in eight (17%) patients. There were three early complications, two of which were ileoureteral anastomotic leaks, one managed by reoperation, the second by percutaneous drainage, and one moderate hydronephrosis managed expectantly. There were five late complications; three patients had ureteral stricture/stenosis, leading to nephrectomy in one patient and percutaneous stenting in two patients. Two patients developed late hydronephrosis, so far managed expectantly. There was one perioperative death. After a median follow-up of 16.83 months, 20 patients were dead of the disease, 6 were alive with disease recurrence, 2 were dead of other causes, and 19 had no evidence of disease. Three-year actuarial disease-specific survival was 34%. Conclusions: Complete resection of bulky primary or locally recurrent rectal cancer can be performed with acceptable urological morbidity. Complete resection was obtained in 89% of patients, with 72% having urological organ invasion. Overall urological complications of 17% are acceptably low despite intensive perioperative radiation and chemotherapy. Disease-specific survival in these patients remains limited. |
| Keywords: | adult; treatment outcome; aged; middle aged; surgical technique; major clinical study; postoperative complication; postoperative complications; survival time; cystectomy; urinary diversion; pelvis exenteration; urinary reservoirs, continent; recurrent disease; rectal neoplasms; rectum cancer; rectal cancer; pelvic exenteration; humans; human; male; female; article |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 6 |
| Issue: | 8 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 1999-12-01 |
| Start Page: | 732 |
| End Page: | 738 |
| Language: | English |
| PUBMED: | 10622500 |
| PROVIDER: | scopus |
| DOI: | 10.1007/s10434-999-0732-x |
| DOI/URL: | |
| Notes: | Article --Presented at the 52nd Annual Meeting of Society of Surgical Oncology that took place March 4–7, 1999 in Orlando, FL-- Export Date: 16 August 2016 -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work