Genitourinary Outcomes in Patients Undergoing Pelvic Exenteration in an Australian Quaternary Centre.

Abstract

Background: Pelvic exenteration (PE) including en-block resection of two or more adjacent pelvic organs, regional lymph nodes, and pelvic side wall is a major surgical undertaking with associated morbidity. This study aims to assess the rate of urological intervention and complications of PE at an Australian quaternary centre.

Methods: Patients undergoing PE with a genitourinary component between January 2003 and July 2021 were included. Data were collected prospectively and analyzed retrospectively. Complications were defined as early (< 30 days) or late (≥ 30 days) using the Clavien-Dindo classification.

Results: A total of 424 patients underwent PE, of whom 213 (50.2%) had a genitourinary component. Early post-operative (30-day) mortality was 0.5% and overall survival was 59.6%. Early urological complications occurred in 106 (49.8%) patients, with 11 (5.2%) experiencing an early urine leak and five (2.3%) sustaining ureteric injury. A late urological complication eventuated in 56 (26.3%) patients, with 19 (8.9%) patients developing non-malignant ureteric stricture requiring upper tract intervention. Chronic kidney disease developed post-operatively in 39 (18.3%) patients at the completion of patient follow-up. Female sex and primary (versus recurrent) malignancy were the only statistically significant predictors of new chronic renal impairment (OR [95% CI] 2.86 (1.33-6.16) and 2.18 (1.09-4.34), respectively). No pre-operative clinicopathological factors predicted urine leak.

Conclusions: Our experience with PE over a long follow-up period demonstrates urological complication rates consistent with the literature associated with urinary diversion and anastomosis, with expected rates of urine leak and ureteric stricture. Further research is required to better delineate and mitigate risk factors for genitourinary complications.