Complications of pelvic exenteration
J. G. Jakowatz, D. Porudominsky, D. U. Riihimaki, M. Kemeny, W. A. Kokal, P. S. Braly, J. J. Terz and J. D. Beatty
This report is based on a retrospective review of 104 patients who had
undergone pelvic exenteration for advanced malignancy over a 29-year period
(1956 to 1984, inclusive). Fifty-one patients (49%) developed major
complications of the operative field involving the gastrointestinal tract
(fistula or obstruction), the urinary tract (fistula, infection, or
obstruction), or the wound (abscess, dehiscence/necrosis, or hemorrhage).
No association was identified between the complication rate and organ of
primary disease, extent of disease, tumor histology, or extent of
resection. Patients receiving pelvic radiotherapy prior to exenteration had
a much higher complication rate (39/58, 67%) than patients having had no
radiotherapy (12/46, 26%). Reconstruction of the irradiated pelvis after
exenteration by omental flap, colonic advancement, and/or myocutaneous
flaps decreased the complication rate from 82% (27/33) to 48% (12/25). The
operative mortality of pelvic exenteration was 2.9% and the actuarial
five-year survival rate was 27%.
