Abstract No. 110: Percutaneous management of post surgical pelvic abscesses in patients with rectal cancer: does neo-adjuvant chemo-radiation impact outcome?

Abstract

The purpose of this study was to evaluate the impact of pre and post-operative neoadjuvant chemoradiation on the clinical outcome of percutaneous drainage of pelvic abscesses developing in patients with rectal cancer after surgical resection. The study included a retrospective review of 45 patients (M: F-25:20, mean age-66 yrs, age range: 29-91yrs) with rectal cancer who underwent CT guided percutaneous drainage of pelvic abscesses developing after low anterior or abdomino-perineal resection. In this cohort, thirty-one patients (M: F-19:12, mean age -65 yrs, age range 29-91yrs) had received neoadjuvant chemoradiation either prior to or after surgical resection (Group A) and fourteen patients did not receive any chemoradiation (Group B). The electronic medical records and imaging studies in these patients were retrospectively evaluated to determine the abscess characteristics, details of catheter drainage and clinical outcome. A total of 72 CT-guided percutaneous abscess drainage procedures were performed on the 45 patients (Group A, n=52 and Group B, n=20). The technical success rate for CT guided catheter drainage of pelvic abscess was 97% (70/72). The mean period of catheter drainage was significantly longer in patients receiving peri-operative chemo-radiation (mean period: 107 days vs 27 days, p=0.02). Enteric fistulas complicating drainage of pelvic abscesses were also more common in chemo-radiation group [A: 42% (21/50), B: 21% (4/19)]. Recurrence of abscesses requiring re-drainage or catheter manipulation was also higher in pelvic abscesses in the chemoradiation group (54% vs 40%). Percutaneous CT guided catheter drainage is useful and effective in the management of pelvic abscesses developing after low anterior or abdomino-perineal resection in patients with rectal cancer. Peri-operative chemoradiation impacts outcome after abscess drainage necessitating prolonged drainage, frequent recurrences and multiple catheter manipulations.