Intestinal Complications After Pelvic Exenterations in Gynecologic Oncology

Abstract

The present study reviews the frequency of intestinal complications in patients having undergone pelvic exenteration in our department between July 1999 and June 2008. Ninety patients with pelvic exenteration were included. R0 resection was achieved in 61 patients (67.8%), R1 in 20 patients (22.2%), and R2 in 9 patients (10.0%). Sixty-four patients had a rectal resection, all less than 7 cm from the anal verge. Forty-two of them had a rectal anastomosis; in 23 cases, with a protective colostomy. The other 22 patients had a terminal colostomy. Fifty-three patients had an ileal anastomosis for bladder reconstruction by ileal conduit, and 29 patients had an ileo-ascendostomy for an ileocecal pouch.Twenty-three patients (25.6%) needed surgical intervention for complications; anastomotic dehiscence being most frequent with 7 cases (7.8%). Three leakages appeared in ileal anastomoses (3/53, 5.7%) and 4 in rectal anastomoses (4/42, 9.5%). Although not significantly, the risk of symptomatic leakage was lower for patients with a protective colostomy (1/23, 4.3%) than for those without (3/19, 15.7%). We found no correlation between the preceding radiotherapy or chemotherapy and the frequency of breakdown of rectal anastomosis. The risk of intestinal complications in exenterative surgery is moderate and not higher than in surgery for rectal cancer. Clinical appearance and, hence, relevance of anastomotic leakage may be reduced by a temporary diverting stoma.