Lazarovich A, Drori T, Guttman Y, Rosenzweig B, Ben-Yaaqov A, Korach J, Nissan A, Dotan Z A
Department of Urology, Chaim Sheba Medical Center, Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Department of Surgical Oncology C, Chaim Sheba Medical Center, Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Heliyon. 2024 Apr 12;10(8):e29640. doi: 10.1016/j.heliyon.2024.e29640. eCollection 2024 Apr 30.
Pelvic exenteration (PE) is a major surgical procedure used as a salvage therapy for patients with locally advanced or recurrent pelvic malignancies. Urinary reconstruction is a major part of PE and is often associated with high rates of post-operative complications. In the current study we evaluate the short and long-term urological outcomes following PE for Colo-Rectal (CR) and gyneco-oncological (GO) malignancies.
Study included 22 patients who underwent PE for recurrent or locally advanced CR and GO malignancies in our institution between the years 2010-2018. The endpoint was post-operative freedom from urological complications.
Of 22 patients included, 13 (59 %) and 9 (41 %) underwent PE for CR and GO malignancies respectively. The mean age of the patients was 54 years. The median follow-up was 19 months. Seven (78 %) patients with GO malignancy and 11 (85 %) with CR malignancy underwent PE for local recurrence. Hydronephrosis prior to surgery existed in 8 (36.3 %) patients, of which, 5 patients required kidney drainage via nephrostomy tube. Two patients underwent posterior pelvic exenteration (PPE) with bladder preservation whereas the remaining 20 underwent cystectomy with urinary diversion by ileal conduit. Hydronephrosis post PE developed in 13 patients (59 %). eight (36 %) patients needed kidney drainage by nephrostomy tubes post PE, of these, 6 (75 %) had disease recurrence. The 2 years freedom from kidney drainage was 68 %, however the median time for kidney drainage was 0.5 months. The median overall survival was 12.5 months.
The rate of urological complications following PE is relatively high and associated with disease recurrence.
盆腔脏器切除术（PE）是一种主要的外科手术，用作局部晚期或复发性盆腔恶性肿瘤患者的挽救性治疗。尿路重建是PE的主要组成部分，且常与高术后并发症发生率相关。在本研究中，我们评估了针对结直肠癌（CR）和妇科肿瘤（GO）恶性肿瘤进行PE后的短期和长期泌尿系统结局。
研究纳入了2010年至2018年间在我们机构因复发性或局部晚期CR和GO恶性肿瘤接受PE的22例患者。终点是术后无泌尿系统并发症。
在纳入的22例患者中，分别有13例（59%）和9例（41%）因CR和GO恶性肿瘤接受了PE。患者的平均年龄为54岁。中位随访时间为19个月。7例（78%）GO恶性肿瘤患者和11例（85%）CR恶性肿瘤患者因局部复发接受了PE。术前8例（36.3%）患者存在肾积水，其中5例患者需要通过肾造瘘管进行肾脏引流。2例患者接受了保留膀胱的后盆腔脏器切除术（PPE），而其余20例患者接受了膀胱切除术并通过回肠导管进行尿流改道。PE后13例患者（59%）出现肾积水。8例（36%）患者在PE后需要通过肾造瘘管进行肾脏引流，其中6例（75%）出现疾病复发。无肾脏引流的2年生存率为68%，然而肾脏引流的中位时间为0.5个月。中位总生存期为12.5个月。
PE后的泌尿系统并发症发生率相对较高，且与疾病复发相关。
