Urological leaks after pelvic exenterations comparing formation of colonic and ileal conduits

• Published in: European journal of surgical oncology Vol. 38; no. 4; pp. 361 - 366
• Main Authors: Teixeira, S.C, Ferenschild, F.T, Solomon, M.J, Rodwell, L, Harrison, J.D, Young, J.M, Vasilaras, A, Eisinger, D, Lee, P, Byrne, C
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.04.2012
• Subjects: Aged; Anastomosis, Surgical; Anastomotic Leak - etiology; Colon - surgery; Colorectal Neoplasms - surgery; Female; Genital Neoplasms, Female - surgery; Hematology, Oncology and Palliative Medicine; Humans; Ileal conduit; Ileum - surgery; Intestinal Fistula - etiology; Length of Stay; Male; Neoplasms; New South Wales; Pelvic exenteration; Pelvic Exenteration - adverse effects; Pelvic Exenteration - methods; Postoperative Complications - etiology; Prospective Studies; Risk factors; Surgery; Treatment Outcome; Urinary diversion; Urinary Diversion - methods; New South Wales; Pelvic exenteration; Ileal conduit; Urinary diversion; Surgery; Neoplasms; Risk factors
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2011.12.002

Abstract Background The aim of this study was to assess possible risk factors for urinary leakage of a newly formed urinary conduit after a partial or total pelvic exenteration. Methods An analysis was conducted from prospectively collected data of patients who underwent a pelvic exenteration with conduit formation for advanced and recurrent pelvic cancer. Results Of 232 patients undergoing a pelvic exenteration, 74 (32%) had a conduit formed. Of these, 47 (64%) had an ileal conduit compared with 27 (36%) a colonic conduit. Twelve (16%) patients developed a leak, of which nine occurred within the first month. Factors associated with a conduit leak included involvement of R2 surgical margins (43%), the magnitude of the exenteration and a current cardiovascular medical history (27%). Leaks were not found to be associated with either radiotherapy or chemotherapy. The 30-day leak rate for ileal conduits was 17% (8/47) and 4% (1/27) for colonic conduits with enterocutaneous fistula only occurring in the ileal conduit group (2/47). Fistula, drained collections and sepsis occurred in 40% of ileal and 19% of colonic conduits ( p  < 0.01). Patients with a conduit leak had a longer length of stay (59 versus 23 days, p  < 0.001). Conclusions Urine leaks after conduit formation in association with exenterations are relatively common with a prolonged length of hospital stay. Positive surgical margins and exenterations involving all four quadrants of the pelvis were associated with higher leak rates. There was no evidence of a difference between ileal and colonic conduits and number of leaks. However colonic conduits had less total complications including sepsis, leak and pelvic collections with comparatively no complications of a small bowel fistula.