Comparation between the Bricker ileal conduit vs double-barrelled wet colostomy after pelvic exenteration for gynaecological malignancies

Double-Barrel Urocolostomy After Pelvic Exenteration: Short-Term Morbidity and Patient-Reported Quality of Life

BACKGROUND

Total pelvic exenteration is a radical surgical procedure for advanced pelvic malignancies. Traditionally, an ileal conduit is created on the right abdominal wall for urinary diversion and an end-colostomy on the left abdominal wall for fecal diversion. However, this approach is associated with increased morbidity and a negative impact on quality of life (QoL). A unilateral double-barrel urocolostomy (DBUC) offers an alternative using the sigmoid colon for urinary drainage. This can potentially reduce complications, improve QoL, and preserve the right vertical rectus abdominis muscle (VRAM) flap for pelvic reconstruction. This study aimed to evaluate the impact of the DBUC on 90-day morbidity and QoL of patients undergoing pelvic exenteration for locally advanced colorectal and anal cancer.

METHODS

Data were prospectively collected from all patients who underwent pelvic exenteration with DBUC reconstruction for colorectal and anal cancer at our tertiary care center between January 2020 and May 2023.

RESULTS

This study enrolled 20 patients. Postoperative complications were observed in 19 patients, including seven major complications. Two complications were directly attributable to the DBUC. Patients reported favorable QoL outcomes in terms of global health, functional ability, and symptom management, with expected limitations in physical performance due to extensive abdominal surgery. At 1 year after surgery, all the patients preferred the DBUC over separate bilateral ostomies.

CONCLUSION

The DBUC procedure has demonstrated safety and efficacy in terms of short-term morbidity and favorable patient-reported QoL, making it an attractive alternative to dual ostomies for patients undergoing pelvic exenteration, particularly when VRAM reconstruction is considered.

Pelvic exenteration: a retrospective study in a tertiary referral cancer center in the UK

BACKGROUND

Pelvic exenteration (PE) is an extensive surgery that is indicated in cases of recurrent advanced gynecological cancer with curative and sometimes palliative intent. The procedure is associated with both high morbidity and mortality and as such is considered a highly specialist procedure. The aim of the study was to analyze surgical outcomes in women who underwent PE for advanced gynecological malignancy in a tertiary cancer referral center over 11 years.

METHODS

This is an observational retrospective single-center study. There were 17 patients included who underwent PE in Hull Royal Infirmary Hospital (Hull, UK) between 2010 and 2021. The main outcome measures were the perioperative complications, overall survival (OS), and recurrence free survival (RFS). Cumulative survival rates were reported at 1, 3 and 5 years. Univariate Cox regression analysis was undertaken to analyze factors that are prognostic for OS and RFS. Hazard Ratios (HR) with 95% confidence intervals (95% CI) were computed from the results of the Cox regression analyses. Kaplan-Meier survival curves were generated to visually display estimates of OS and RFS over the follow-up period.

RESULTS

The median age at the time of surgery was 63.0 (IQR: 48.0-71.0). All patients received surgery with curative intent and complete tumor resection (R0) was achieved in 94.1% of cases. An overall 5-year survival was achieved in 63.7% of patients. Mean overall survival (OS) was 8.4 years (95% CI: 7.78-9.02). The RFS was 5.0 years (95% CI: 4.13-5.87). Both OS and RFS were significantly negatively affected by the hospital stay (P=0.020 and P=0.035, respectively), but not by the type of surgery (P=0.263 and P=0.826, respectively).

CONCLUSIONS

The results of the study demonstrated stable and comparable outcomes in patients undergoing pelvic exenteration.

Trans Oblique Ileal Conduit Technique Has a Low Risk of Parastomal Hernias

OBJECTIVE

To outline our surgical technique and outcomes of a ipsilateral "transoblique" ileal conduit performed during pelvic exenteration with a Vertical Rectus Abdominis Myocutaneous flap. We report hernia rates in a transrectus group as reference.

METHODS

We identified patients from January 2007 to August 2020. The transoblique conduit is placed on the ipsilateral side as the VRAM, through the internal, external oblique, and transverse abdominis muscles. Stomal hernias were assessed radiologically. Transrectus patients were those undergoing radical cystectomy matched based on surgery date, age, and sex in a 3:1 ratio. We employed a Kaplan-Meier plot to visualize the duration between surgery and hernia. We calculated the hernia rate 2 years after surgery. Additionally, we present the 30-day postoperative complication rate.

RESULTS

Fifty underwent transoblique conduits and we matched them to 190 transrectus patients. Sixty-seven percent were men with a median age of 62. Exactly 10/50 patients in the transoblique and 44/190 in the transrectus group developed a hernia, with a median follow-up of 2.2 years (IQR 0.8, 4.0). The 2-year KM-estimated parastomal hernia rate was 14% (95% CI 1.6%, 25%) for the transoblique conduits, 21% (95% CI 15%, 28%) for the transrectus and 24% (95% CI 6.5%, 39%) for colostomies. Among the transoblique patients, 22 (44%) experienced at least 1 postoperative complication.

CONCLUSION

A transoblique ileal conduit is safe in patients undergoing a right VRAM flap during a pelvic exenteration with a low parastomal hernia and complication rates.

A single centre experience on the formation of double barrelled uro-colostomy in pelvic exenteration surgery: a cohort study

BACKGROUND

Double barrelled uro-colostomy (DBUC) is an alternative to traditional ileal conduit (IC) and separate colostomy in patients requiring simultaneous urinary and faecal diversion for reconstruction in pelvic exenteration surgery (PES).

METHODS

This cohort study evaluated short- and long-term morbidity and mortality associated with DBUC formation in 20 consecutive adult patients undergoing PES in an Australian Complex Pelvic Surgical Unit. Data were obtained from a prospective database.

RESULTS

Mean age 59 years (range 27-76 years). PES was performed for malignant disease in 18 patients (curative intent in 17). Mean operative duration 11.8 h (range 7-17 h). Mean follow-up duration 29.1 months (range 2.6-90.1 months). Early DBUC-related complications occurred in four patients (20.0%): urinary tract infection (UTI)/urosepsis (n = 4) and early ureteric stenosis requiring intervention (n = 1). Late DBUC-related complications occurred in five patients (25.0%): recurrent UTI/urosepsis (n = 4), chronic kidney disease (n = 4), ureteric stenosis (n = 2) and parastomal hernia (n = 4). No mortality occurred secondary to a DBUC complication.

CONCLUSION

DBUC is a safe reconstructive option with acceptable morbidity profile in patients requiring simultaneous urinary and faecal diversion.