Management of enteroperineal fistulas following pelvic exenteration: Insights from a high-volume referral centre

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease Pub Date : 2025-04-27 DOI:10.1111/codi.70085

Darius Kang Lie Aw, Kilian G. M. Brown, Jessica El-Hayek, Mollie Cahill, Kirk K. S. Austin, Peter Jun Myung Lee, Chris Byrne, Michael J. Solomon

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Abstract

Aim

Total pelvic exenteration (TPE) has emerged as the standard treatment for advanced anorectal, genitourinary and soft-tissue pelvic tumours. Long-term complications, particularly empty pelvis syndrome (EPS) leading to enteroperineal fistula (EPF), remain inadequately addressed. The surgical management of EPF poses significant challenges, with limited published data and no official guidelines. This study aimed to investigate the incidence and outcomes of EPFs after TPE and to describe the management of reoperative surgery in this patient cohort.

Method

Patients who underwent TPE at Royal Prince Alfred Hospital, Sydney, Australia, between 2009 and 2024 were identified. Clinical data from a prospectively maintained database on reoperative surgery for EPFs were obtained. Patients were excluded if reoperative surgery was clearly unrelated to previous exenteration. Comparisons were then made between the two strategies used for surgical management of EPFs, namely small bowel resection with anastomosis and intestinal bypass with distal limbs exclusion.

Results

Among 491 patients who underwent TPE, 22 (4.5%) developed an EPF requiring reoperative procedures. The 30-day major complication rate was 18.2%. Postoperative complications were prevalent (95.2%) across both groups. The median time to EPF surgery post-TPE was 21.7 months. Notably, intensive care unit (ICU) admission was 2 days shorter and length of stay was 14 days shorter in the bypass group than in the small bowel resection with anastomosis group, although both differences were not statistically significant.

Conclusion

Strategies for preventing EPFs remain elusive; however, surgical management is feasible with acceptable short-term outcomes. The optimal strategy should be tailored to individual patient characteristics.

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盆腔切除术后肠会阴瘘的处理：来自一个大容量转诊中心的见解

目的全盆腔切除（TPE）已成为晚期肛门直肠、泌尿生殖系统和盆腔软组织肿瘤的标准治疗方法。长期并发症，特别是导致肠会阴瘘（EPF）的骨盆空综合征（EPS），仍然没有得到充分解决。EPF的外科治疗面临重大挑战，公布的数据有限，没有官方指南。本研究旨在调查TPE后EPFs的发生率和结局，并描述该患者队列的再手术处理。方法选取2009年至2024年在澳大利亚悉尼阿尔弗雷德王子医院接受TPE治疗的患者。从EPFs再手术的前瞻性数据库中获得临床数据。如果再手术与先前的拔管明显无关，则排除患者。然后比较了用于EPFs手术治疗的两种策略，即小肠切除吻合和肠旁路切除远端肢体排除。结果在491例TPE患者中，22例（4.5%）发生EPF，需要再手术。30天主要并发症发生率为18.2%。两组术后并发症发生率均为95.2%。tpe后至EPF手术的中位时间为21.7个月。值得注意的是，与吻合小肠切除组相比，旁路组重症监护病房（ICU）入院时间缩短2天，住院时间缩短14天，但两者差异无统计学意义。结论预防EPFs的策略仍然难以捉摸；然而，手术治疗是可行的，短期结果可接受。最佳策略应根据患者的个体特征进行调整。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.