Efficacy of an additional flap operation in bladder-preserving surgery with radical prostatectomy and cystourethral anastomosis for rectal cancer involving the prostate

• Published in: Surgery today (Tokyo, Japan) Vol. 47; no. 9; pp. 1119 - 1128
• Main Authors: Noguchi, Keita, Nishizawa, Yuji, Komai, Yoshinobu, Sakai, Yasuyuki, Kobayasi, Akihiro, Ito, Masaaki, Saito, Norio
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.09.2017
• Subjects: Adult; Aged; Anastomosis, Surgical - methods; Anastomotic Leak - prevention & control; Colorectal Neoplasms - surgery; Humans; Ileum - transplantation; Male; Medicine; Medicine & Public Health; Middle Aged; Organ Sparing Treatments - methods; Original; Original Article; Postoperative Complications - prevention & control; Prospective Studies; Prostatectomy - methods; Risk; Surgery; Surgical Flaps; Surgical Oncology; Time Factors; Urethra - surgery; Urinary Bladder - surgery; Bladder-preserving surgery; Additional flap operation; Colorectal cancer; Total pelvic excision
• ISSN: 0941-1291; 1436-2813; 1436-2813
• DOI: 10.1007/s00595-017-1484-z

Purpose Sphincter-preserving operations performed with bladder-preserving surgery and a cystourethral anastomosis (CUA) do not require a urinary stoma, but leakage from the CUA may develop. The aim of this study was to evaluate the efficacy of performing an additional flap operation. Methods The subjects were 39 patients who underwent bladder-preserving surgery for advanced rectal cancer involving the prostate, between 2001 and 2015.32 of whom had a CUA and one of whom had a neobladder. Five of these 32 patients underwent an ileal flap operation, 2 underwent an omental flap operation, and 3 underwent an operation using both flaps. Results Leakage developed in 3 (30%) of the 10 patients who underwent additional flap operations, but in 14 (60.9%) of the 23 patients who did not undergo a flap operation. The mean periods of catheterization for the patients who suffered leakage were 31 weeks (8–108 weeks) in those without a flap and 16 weeks (8–20 weeks) in those with a flap. Four (33.3%) of the 12 patients with leakage after surgery without a flap had a period of urinary catheterization >30 weeks, and 2 (16.7%) had leakage of CTCAE grade 3. There were no cases of leakage after flap surgery. Conclusion An additional flap operation may decrease the risk of leakage from a CUA.