Long‐term surgical complications following pelvic exenteration: Operative management of the empty pelvis syndrome

Aim Pelvic exenteration (PE) has become the standard of care for locally advanced and recurrent rectal cancer. The high short‐term morbidity reported from this procedure is well established; however, longer term complications of such radical surgery and their management have not been fully addressed...

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Bibliographic Details
Published in:Colorectal disease 2022-12, Vol.24 (12), p.1491-1497
Main Authors: Sutton, Paul A., Brown, Kilian G. M., Ebrahimi, Nargus, Solomon, Michael J., Austin, Kirk K. S., Lee, Peter J.
Format: Article
Language:English
Subjects:
Disease management
Electronic medical records
empty pelvis syndrome
Fistula
Fistulae
Humans
Morbidity
Neoplasm Recurrence, Local - surgery
Patients
pelvic exenteration
Pelvic Exenteration - adverse effects
Pelvic Exenteration - methods
Pelvis
Pelvis - surgery
Perineum
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Postoperative Complications - surgery
Rectal Neoplasms - complications
Retrospective Studies
Surgery
Surgical outcomes
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Summary:Aim Pelvic exenteration (PE) has become the standard of care for locally advanced and recurrent rectal cancer. The high short‐term morbidity reported from this procedure is well established; however, longer term complications of such radical surgery and their management have not been fully addressed. This study aimed to investigate the incidence, indications and outcomes of long‐term (more than 90‐day) reoperative surgery in this group of patients, with a focus on the empty pelvis syndrome (EPS). Methods Clinical data were extracted from a prospectively maintained database, with additional data pertaining to indications, operative details and outcomes of reoperative surgery obtained from electronic medical records. Patients were excluded if reoperative surgery was endoscopic or radiologically guided, was for the investigation or treatment of recurrent disease, or was clearly unrelated to previous surgery. Results Of 716 patients who underwent PE, 75 (11%) required 101 reoperative abdominal or perineal procedures, 52 (51%) of which were in 40 (6%) patients for complications of EPS. This group were more likely to have undergone a total PE (65% vs. 43%; P 
ISSN:1462-8910
1463-1318
DOI:10.1111/codi.16238