Urological Outcomes and Adverse Events Following Total Pelvic Exenteration for Locally Advanced and Recurrent Rectal Cancer: A Single-center Retrospective Study.

OBJECTIVE

To assess urological complications in patients undergoing total pelvic exenteration (TPE) for locally advanced (LARC) and recurrent rectal cancer (RRC) as publications in this area are limited. Secondary objectives were to assess whether LARC vs RRC or radiation status affected urological outcomes.

METHODS

Single-center, retrospective study of TPE patients between January 2017 and December 2022. Electronic records were evaluated to extract data. Postoperative outcomes were analyzed using two-tailed t-tests, Mann-Whitney U tests and chi-squared tests. Urological complications were analyzed using simple logistic regression.

RESULTS

A total of 128 patients underwent TPE (97 LARC, 31 RRC). 90 (70.3%) received neoadjuvant radiotherapy. The overall urological complication rate was 51.6%. Transient acute kidney injury and urinary tract infection were the two most common complications occurring in 38 (29.7%) and 33 (25.8%) respectively. 23 (18.0%) had at least one major complication of Clavien-Dindo III/IV related to the urinary system. Ureteroenteric stricture rate was 7.0% and 14.1% needed a reoperation for urological complications. There was no association between the overall incidence of urological complications and radiation status (OR 0.81 [0.37-1.73], P=.586) or between patients with LARC and RRC (OR 1.68 [0.75-3.93], P=.216).

CONCLUSION

Urological complications are common post-TPE. The urological complication rate is similar in LARC and RRC and radiation status did not affect outcomes in this cohort.