Achim Troja*, Nader El-Sourani and Hans-Rudolf Raab
Department for General and Visceral Surgery, Klinikum Oldenburg AöR, European Medical School, GermanyFulltext PDF
Introduction: Pelvic exenteration is a potential curative treatment option for locally advanced primary tumors and recurrent tumors of the small pelvis. Total pelvic exenteration is an extensive operation that involves en bloc resection of multiple organs. Several surgical techniques are available for urinary diversion following extensive surgery. In some cases, bladder-preservation is possible with subsequent urinary diversion. This retrospectively series analysis and compares bladderpreserving techniques with cycstectomies with morbidity, mortality and quality of life. Material and Methods: Between 2013 and 2017 a total pelvic exenteration was performed in 28 patients. Factors such as tumor entity, morbidity, mortality, sacrectomy and bladder-preservation were analyzed. Results: A total of 28 patients were operated. N=15 were male, n=13 were female. N=12 received a bladder-preservation surgery. The mean age was 62 years. The median hospital stay was 38 days. The median follow-up was 15 months. There was a total of 10 surgical morbidities. The mortality rate was 21%. Conclusion: Bladder-preservation in pelvic exenteration is possible and is not associated with a higher R1 or R2 resection. However, surgical morbidity following this technique is high and must therefore bet be considered critically prior to surgery. Therefore, we recommend a urinary diversion (e.g. ileal conduit) in all patients undergoing pelvic exenteration for locally advanced or recurrent tumors.
Troja A, El-Sourani N, Raab H-R. Outcome of Bladder Preservation Techniques in Patients Undergoing Pelvic Exenteration for Locally Advanced and Recurrent Malignancies. Clin Surg. 2019; 4: 2626.