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

Nikki Kerdegari; Calum T Singh; Findlay MacAskill; Christopher Allen; Sachin Malde; Rajesh Nair; Ramesh Thurairaja; Muhammad S Khan; Mark George; Alexis Schizas; Arun Sahai

doi:10.1016/j.urology.2024.12.021

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

Urology. 2024 Dec 20:S0090-4295(24)01211-1. doi: 10.1016/j.urology.2024.12.021. Online ahead of print.

Authors

Affiliations

¹ King's College London, London, United Kingdom.
² Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
³ Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
⁴ King's College London, London, United Kingdom; Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. Electronic address: arun.sahai@gstt.nhs.uk.

PMID: 39710077
DOI: 10.1016/j.urology.2024.12.021

Abstract

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-centre, retrospective study of TPE patients between January 2017 and December 2022. Electronic records were evaluated to extract data. Postoperative outcomes were analysed using two-tailed t-tests, Mann-Whitney U tests and chi-squared tests. Urological complications were analysed 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 (AKI) and urinary tract infection (UTI) 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. Uretero-enteric stricture rate was 7.0% and 14.1% needed a re-operation 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 = 0.586) or between patients with LARC and RRC (OR 1.68 [0.75 - 3.93], p = 0.216).

Conclusions: 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.