| Author |
Gas, J. Beauval, J. B. Chalret du Rieu, M. Bou Nasr, E. Philis, A. Kirzin, S. Thoulouzan, M. Soulié, M. Ghouti, L. |
| Description |
Author Affiliation: Gas J ( Département d'urologie, d'andrologie et de transplantation rénale, CHU Toulouse Rangueil, 1, avenue du Pr-Jean-Poulhes, 31000 Toulouse, France. Electronic address: jeromegas@hotmail.fr.); Beauval JB ( Département d'urologie, d'andrologie et de transplantation rénale, CHU Toulouse Rangueil, 1, avenue du Pr-Jean-Poulhes, 31000 Toulouse, France.); Chalret du Rieu M ( Département de chirurgie digestive et oncologique, CHU Toulouse Purpan, place du Docteur Baylac, 31059 Toulouse, France.); Bou Nasr E ( Département d'urologie, d'andrologie et de transplantation rénale, CHU Toulouse Rangueil, 1, avenue du Pr-Jean-Poulhes, 31000 Toulouse, France.); Philis A ( Département de chirurgie digestive et oncologique, CHU Toulouse Purpan, place du Docteur Baylac, 31059 Toulouse, France.); Kirzin S ( Département de chirurgie digestive et oncologique, CHU Toulouse Purpan, place du Docteur Baylac, 31059 Toulouse, France.); Thoulouzan M ( Département d'urologie, d'andrologie et de transplantation rénale, CHU Toulouse Rangueil, 1, avenue du Pr-Jean-Poulhes, 31000 Toulouse, France.); Soulié M ( Département d'urologie, d'andrologie et de transplantation rénale, CHU Toulouse Rangueil, 1, avenue du Pr-Jean-Poulhes, 31000 Toulouse, France.); Ghouti L ( Département de chirurgie digestive et oncologique, CHU Toulouse Purpan, place du Docteur Baylac, 31059 Toulouse, France.) |
| Abstract |
OBJECTIVE: Pelvic exenteration for rectal cancer is indicated in locally advanced rectal tumors or pelvic recurrence invading adjacent organs. The oncologic goal being a complete R0 resection. Our aim was to study the urinary complications resulting from pelvic exenterations with urinary reconstruction in order to obtain a complete local control of the disease. METHODS: Between April 2004 and June 2013, 42 patients who underwent pelvic exenteration for primary or recurrent rectal adenocarcinoma with urinary tract reconstruction were included. The urinary reconstruction was performed based on preoperative imaging and intraoperative findings. We studied early (within 30 postoperative days) and late urinary morbidity, as well as postoperative carcinologic control. RESULTS: Forty-two exenterations were performed for primary rectal cancer (n=15) or pelvic recurrence (n=27). R0 complete resection was achieved in 64% of patients. The resection was incomplete (R1) on the urinary tract in 9.5% of patients. The urinary reconstruction methods used were: 31 transileal ureterostomies after total exenteration (bricker procedure), 6 ureteral reimplantations on psoic bladder, 2 ureteroileoplasties, 2 partial cystectomies and one ureteral resection with simple ligation. The median follow-up was 20 months. The perioperative mortality was 2.3% (n=1) and postoperative overall morbidity was 64%. Early and late urinary morbidity was 23.8% and 21.4% respectively. Six patients developed major urinary complications (≥ Clavien IIIb). CONCLUSION: Pelvic exenteration with urinary resection resulted in our experience, in a local disease control of 64% (including a 90.5% for the urinary tract) at the price of an acceptable early specific morbidity and a low mortality that seems to justify an aggressive surgical approach. |
