Long-term surgical complications following pelvic exenteration: Operative management of the empty pelvis syndrome

Early detection of deep pelvic surgical site infection by microdialysis after abdominoperineal resection for locally advanced rectal cancer

BACKGROUND

Patients with locally advanced rectal cancer (LARC) treated with (chemo)-radiotherapy before abdominoperineal resection (APR) are at high risk of developing pelvic organ/space surgical site infection (O/S-SSI). This increases morbidity and prolongs length of stay. Vague symptoms delay diagnosis. In microdialysis, thin catheters are placed in tissue enabling monitoring of metabolism. We hypothesize that local metabolic changes related to O/S-SSI might be detected by microdialysis.

METHODS

In a prospective observational study, 38 patients who underwent open APR for LARC were analysed. At the end of surgery microdialysis catheters were placed in remnant tissue of the pelvic floor. Postoperatively, metabolic parameters including lactate, pyruvate, glucose and glycerol were measured, and the lactate-to-pyruvate (L/P) ratio was calculated. Out of 38 patients, 12 (32%) developed O/S-SSI.

RESULTS

O/S-SSI was diagnosed median 9 (range 6-17) days after surgery. On the day of surgery, mean lactate in the O/S-SSI group was 6.0 mmol/L, whereas it was 3.6 mmol/L in the no-O/S-SSI group. ROC analysis (AUC = 0.73), with cut-point lactate 5.7, detected O/S-SSI with 92% sensitivity and 65% specificity. Overall mean lactate was 1.9 mmol/L higher in the O/S-SSI group than in the no-O/S-SSI group (P = 0.002). Overall mean L/P ratio was 34 units higher in the O/S-SSI group (P = 0.001).

CONCLUSIONS

In patients developing pelvic O/S-SSI, tissue lactate and L/P ratio measured by microdialysis were significantly higher and evident already from the day of surgery, 9 days prior to diagnosis, with high negative predictive value and moderate positive predictive value. Local monitoring using microdialysis may aid detection of O/S-SSI.

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

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.

Empty pelvis syndrome as a cause of major morbidity after pelvic exenteration: validation of a core data set

BACKGROUND

Pelvic exenteration (PE) is a potentially curative treatment for advanced pelvic cancers. However, PE procedures are associated with empty pelvis syndrome (EPS), a spectrum of complications including pelvic sepsis, sinus formation, fistulae, and bowel obstruction. Inconsistent reporting has impeded progress in understanding EPS. The PelvEx Collaborative introduced a core data set of descriptors and outcomes to address these issues and the aim of this study was to validate this data set.

METHODS

An observational cohort study applied the EPS core data set to a prospectively maintained PE database. Patterns of major and minor manifestations were evaluated; logistic regression was used to explore relationships between descriptors and outcomes, and inter-descriptor correlation was assessed using Cramer's V.

RESULTS

EPS occurred in 32.1% of patients (105 of 327) and was the leading cause of major morbidity. Infected pelvic collections (occurring in 23.5%) were associated with subsequent chronic sinus formation (OR 3.08, P = 0.01) and fistulae (P = 0.05). The risk of EPS increased with external beam radiotherapy (OR 1.01 per 1 Gy, P = 0.01), sacrectomy (OR 3.78, P < 0.001), total cystectomy (OR 2.46, P = 0.001), internal iliac vessel ligation (unilateral OR 1.94, P = 0.045; bilateral OR 3.65, P < 0.001), and infralevator exenteration (OR 3.69, P < 0.001). Omentoplasty reduced pelvic bowel obstruction (OR 0.27, P = 0.004) and perineal flaps were linked to a higher rate of reconstruction-related major morbidity compared with biological mesh alone (20.8% versus 1.2% respectively, P = 0.002).

CONCLUSION

The PelvEx Collaborative core data set standardizes reporting of EPS, with this study detailing the acute and chronic complications arising as a consequence. Biological mesh was associated with reduced reconstruction-related morbidity compared with perineal flaps. Further validation in additional cohorts is required to address potential confounding factors.

Survivorship issues in long-term survivors of locally recurrent rectal cancer: A qualitative study

AIM

There are increasing numbers of long-term survivors following curative treatment for locally recurrent rectal cancer (LRRC); however, their experiences remain relatively underreported. The aim of this qualitative study was to identify the long-term survivorship issues relevant to these patients.

METHOD

Adults who remained disease free >3 years following treatment for LRRC were invited to participate in an international multicentre study. Semistructured qualitative interviews were conducted either in person, via telephone or via Microsoft Teams and were analysed using a framework method of thematic analysis.

RESULTS

A total of 26 participants were recruited from 11 sites in seven countries. Sixteen (61.5%) participants were male, the median age was 70.5 (33.0-85.0) years, participants were a median of 5.0 (3.0-17.0) years posttreatment, most had undergone surgery for LRRC (n = 24, 92.3%), two participants received neoadjuvant chemo/radiation for LRRC with a complete response. Eight major survivorship themes were identified: (1) experience of long-term follow-up care, (2) unmet needs and areas for improvement, (3) long-term physical effects of cancer and treatment, (4) living with a stoma, urostomy or other urinary device, (5) long-term psychological impact, (6) impact on sexual function and intimate relationships, (7) impact on daily life and (8) feelings surrounding life now, adapting and the future.

CONCLUSION

Participants experienced a wide range of long-term survivorship issues, reflecting the complexity of both LRRC and its treatment. Despite this, most had adapted well. Further work regarding survivorship care in LRRC is required to address the unmet needs and issues highlighted in this study, such as support regarding sexual function.

A Prospective Observational Cohort Study Comparing High-Complexity Against Conventional Pelvic Exenteration Surgery

Background: Conventional pelvic exenteration (PE) comprises the removal of all or most central pelvic organs and is established in clinical practise. Previously, tumours involving bone or lateral sidewall structures were deemed inoperable due to associated morbidity, mortality, and poor oncological outcomes. Recently however high-complexity PE is increasingly described and is defined as encompassing conventional PE with the additional resection of bone or pelvic sidewall structures. This observational cohort study aimed to assess surgical outcomes, health-related quality of life (HrQoL), decision regret, and costs of high-complexity PE for more advanced tumours not treatable with conventional PE. Methods: High-complexity PE data were retrieved from a prospectively maintained quaternary database. The primary outcome was overall survival. Secondary outcomes were perioperative mortality, disease control, major morbidity, HrQoL, and health resource use. For cost-utility analysis, a no-PE group was extrapolated from the literature. Results: In total, 319 cases were included, with 64 conventional and 255 high-complexity PE, and the overall survival was equivalent, with medians of 10.5 and 9.8 years (p = 0.52), respectively. Local control (p = 0.30); 90-day mortality (0.0% vs. 1.2%, p = 1.00); R0-resection rate (87% vs. 83%, p = 0.08); 12-month HrQoL (p = 0.51); and decision regret (p = 0.90) were comparable. High-complexity PE significantly increased overall major morbidity (16% vs. 31%, p = 0.02); and perioperative costs (GBP 37,271 vs. GBP 45,733, p < 0.001). When modelled against no surgery, both groups appeared cost-effective with incremental cost-effectiveness ratios of GBP 2446 and GBP 5061. Conclusions: High-complexity PE is safe and feasible, offering comparable survival outcomes and HrQoL to conventional PE, but with greater morbidity and resource use. Despite this, it appears cost-effective when compared to no surgery and palliation.

Patient-Reported Outcomes in Chinese Patients with Locally Advanced or Recurrent Colorectal Cancer After Pelvic Exenteration

BACKGROUND

Pelvic exenteration (PE) is often the only curative treatment option for selected locally advanced and locally recurrent colorectal cancer associated with significant morbidity. Open and laparoscopic approaches were accepted for this procedure.

OBJECTIVE

This study aimed to examine the Chinese patient-reported outcomes (PROs) and health-related quality of life (HRQoL) after PE.

METHODS

A total of 122 enrolled participants were asked to complete PROs at baseline and 1, 3, 6, 9 and 12 months after PE. PROs included seven symptoms from the National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). The HRQoL was assessed using the Functional Assessment of Cancer Therapy-Colorectal (FACT-C).

RESULTS

The overall postoperative complication rate was 41.0%. Patients experienced lower physical and functional well-being and FACT-C 1 month after surgery, then gradually recovered. The FACT-C score returned to baseline 9 months after surgery. Social and emotional well-being did not show signs of recovery until 6 months after the surgical procedure, and did not fully return to baseline until 12 months post-surgery. Symptom rates of insomnia, anxiety, discouragement, and sadness (composite score >0) did not improve significantly from baseline until 12 months after surgery.

CONCLUSIONS

PE is a feasible treatment choice for locally advanced primary and recurrent colorectal cancer. Social, psychological, and emotional recovery in the Chinese population after PE tends to be slower compared with the physical condition.

Outcomes of chemotherapy/chemoradiation vs. R2 surgical debulking vs. palliative care in nonresectable locally recurrent rectal cancer

Locally recurrent rectal cancer is resected with clear margins in only 50% of cases, and these patients achieve a three-year survival rate of 50%. Outcomes and therapeutic strategies for nonresectable locally recurrent rectal cancer have been much less explored. The aim of the study was to assess the three-year progression-free survival and the three-year overall survival in locally recurrent rectal cancer patients treated by chemotherapy/chemoradiation only vs. chemotherapy/chemoradiation and R2 surgical debulking vs. palliative care. A total of 86 patients affected by nonresectable locally recurrent rectal cancer were included: three-year progression-free survival was 15.8% with chemotherapy/chemoradiation vs. 20.3% with R2 surgical debulking (Log-rank p=0.567), but both rates were higher than best palliative care (0.0%, Log-rank p=0.0004). Three-year overall survival rates were respectively 62.0%, 70.8% and 0.0% (Log-rank p<0.0001). Chemotherapy/chemoradiation (HR 0.33, p=0.028) and R2 surgical debulking with or without chemotherapy/chemoradiation (HR 0.23, p=0.005) were independent predictors of improved progression-free survival on multivariate analysis. In conclusion, both chemotherapy/chemoradiation alone and R2 surgery with or without chemotherapy/chemoradiation provide a survival benefit over palliative care in nonresectable locally recurrent rectal cancer. However, considering that pelvic debulking is burdened by a high rate of complications, and considering its negligible impact on progression-free survival and overall survival when associated to medical therapy, surgery should be avoided in this setting.

Radical resection of locally advanced and recurrent colorectal carcinoma involving major nerve resection: a systematic review of surgical, oncological and functional outcomes

BACKGROUND

The aim of this study was to explore the surgical, oncological and quality of life outcomes in the setting of radical resection of colorectal carcinoma involving major nerve resection.

METHODS

A systematic review of the literature was registered with the International Prospective Register for Systematic Reviews (PROSPERO) and performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify papers relating to outcomes in radical resection of colorectal cancer where major nerve resection was undertaken. Papers were identified from OVID Medline, EMBASE Classic and Web of Science encompassing all publications in English from January 2010 to June 2023. A total of 1357 nonduplicate studies were identified and screened for relevance, with six studies included in the final review.

RESULTS

A total of 354 major nerve resections were undertaken across the six included studies. Overall postoperative morbidity was reported at rates of up to 82%. Two studies considered nerve-resection-specific oncological outcomes, with complete pathological resection achieved at rates comparable to the wider pelvic exenteration cohort (65-68%) and without any overall survival disadvantage being conveyed by major nerve resection (p = 0.78). Two studies considered functional outcomes and noted a transient decrease in physical quality of life over the first 6 months postoperatively (p = 0.041) with significant loss to follow-up. One study considered postoperative pain in nerve resection and noted no significant increase in patient-reported pain scores associated with nerve resection (p = 0.184-0.618).

CONCLUSIONS

Major nerve resections in locally advanced and recurrent colorectal cancer remain understudied but with encouraging initial oncological and functional outcomes. Multicentre collaborative prospective reviews are needed to better elucidate contributors to postoperative morbidity and functional deficits and further establish interventions to ameliorate them.

Eureka: objective assessment of the empty pelvis syndrome to measure volumetric changes in pelvic dead space following pelvic exenteration

BACKGROUND

Large tissue defects following pelvic exenteration (PE) fill with fluid and small bowel, leading to the empty pelvis syndrome (EPS). EPS causes a constellation of complications including pelvic sepsis and reduced quality of life. EPS remains poorly defined and cannot be objectively measured. Pathophysiology of EPS is multifactorial, with increased pelvic dead space potentially important. This study aims to describe methodology to objectively measure volumetric changes relating to EPS.

METHODS

The true pelvis is defined by the pelvic inlet and outlet. Within the true pelvis there is physiological pelvic dead space (PDS) between the peritoneal reflection and the inlet. This dead space is increased following PE and is defined as the exenteration pelvic dead space (EPD). EPD may be reduced with pelvic filling and the volume of filling is defined as the pelvic filling volume (PFV). PDS, EPD, and PFV were measured intraoperatively using a bladder syringe, and Archimedes' water displacement principle.

RESULTS

A patient undergoing total infralevator PE had a PDS of 50 ml. A rectus flap rendered the pelvic outlet watertight. EPD was then measured as 540 ml. Therefore there was a 10.8-fold increase in true pelvis dead space. An omentoplasty was placed into the EPD, displacing 130 ml; therefore, PFV as a percentage of EPD was 24.1%.

CONCLUSIONS

This is the first reported quantitative assessment of pathophysiological volumetric changes of pelvic dead space; these measurements may correlate to severity of EPS. PDS, EPD, and PFV should be amendable to assessment based on perioperative cross-sectional imaging, allowing for potential prediction of EPS-related outcomes.

Extraperitoneal lateral pelvic sidewall excision: a novel rectal-sparing approach for lateral locally recurrent rectal cancer

Locally recurrent rectal cancer (LRRC) involving the lateral pelvic sidewall requires a complex approach to maximize the likelihood of R0 resection, which is the only predictor of survival. The purpose of this report is to describe a novel technique to resect a localized lateral pelvic sidewall LRRC. A 63-year-old male patient was referred for a 15-mm LRRC near the right internal iliac vessels. Endoscopic ultrasound and magnetic resonance imaging excluded any involvement of the pelvic colon or residual rectum. A combined extraperitoneal antero-lateral approach and gluteal access were used to optimize vascular control on the internal iliac vessels, to promptly identify the ureter and to achieve a better posterior exposition of the sciatic notch. This technique allowed a controlled and tailored resection of pelvic sidewall without entering into the abdominal cavity. The postoperative course was uneventful. The pathologic report confirmed clear margins (R0), with one involving obturator lymph node. At 3 months, the patient is alive and free from local re-relapse. A right lung metastasis has occurred, and it was treated by stereotactic radiotherapy. The present report proposes a novel extraperitoneal pelvic sidewall excision to resect lateral LRRC with a colorectal-sparing approach, thus minimizing the risk of exenterative surgery-related complications. A proper selection of patients is mandatory, as the proposed technique could not be generalized as the standard of care in all lateral LRRCs.

The empty pelvis syndrome: a core data set from the PelvEx collaborative

BACKGROUND

Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored.

METHOD

Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition.

RESULTS

One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed.

CONCLUSIONS

EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.

PelvEx Collaborative. Beating the empty pelvis syndrome: the PelvEx Collaborative core outcome set study protocol

INTRODUCTION

The empty pelvis syndrome is a significant source of morbidity following pelvic exenteration surgery. It remains poorly defined with research in this field being heterogeneous and of low quality. Furthermore, there has been minimal engagement with patient representatives following pelvic exenteration with respect to the empty pelvic syndrome. 'PelvEx-Beating the empty pelvis syndrome' aims to engage both patient representatives and healthcare professionals to achieve an international consensus on a core outcome set, pathophysiology and mitigation of the empty pelvis syndrome.

METHODS AND ANALYSIS

A modified-Delphi approach will be followed with a three-stage study design. First, statements will be longlisted using a recent systematic review, healthcare professional event, patient and public engagement, and Delphi piloting. Second, statements will be shortlisted using up to three rounds of online modified Delphi. Third, statements will be confirmed and instruments for measurable statements selected using a virtual patient-representative consensus meeting, and finally a face-to-face healthcare professional consensus meeting.

ETHICS AND DISSEMINATION

The University of Southampton Faculty of Medicine ethics committee has approved this protocol, which is registered as a study with the Core Outcome Measures in Effectiveness Trials Initiative. Publication of this study will increase the potential for comparative research to further understanding and prevent the empty pelvis syndrome.

TRIAL REGISTRATION NUMBER

NCT05683795.

Transperineal endoscopic approach with GelPOINT V-path in laparoscopic pelvic exenteration for postirradiated recurrent cervical cancer

Pelvic exenteration (PE) is a highly invasive procedure associated with high morbidity and mortality rates. Laparoscopy is a promising option to reduce this invasiveness, and laparoscopic PE significantly reduces blood loss and shortens hospital stays. In the case of a large tumor with invasion to the surrounding organs, laparoscopic dissection around the pelvic floor is sometimes problematic owing to restrictions on handling instruments. To overcome these limitations, we performed a transperineal endoscopic approach using the GelPOINT V-path in addition to laparoscopic PE. This approach enabled dissection around the pelvic floor without the abovementioned obstacles under magnified visualization. As a result, we could dissect the pelvic floor precisely with a reduction of the dead pelvic space, which might contribute to reduced rates of postoperative complications while ensuring oncologic outcomes.

Pelvic Exenteration for Squamous Cell Carcinoma of the Anus: Oncological, Morbidity, and Quality-of-Life Outcomes

BACKGROUND

Salvage surgery is the only potentially curative treatment option for recurrent squamous cell carcinoma of the anus. Where adjacent pelvic viscera, soft tissues, and bone are involved, pelvic exenteration with a wide perineal excision may be required to ensure clear surgical margins and increase the likelihood of long-term survival.

OBJECTIVE

To report oncological, morbidity, and quality-of-life outcomes of pelvic exenteration for anal squamous cell carcinoma.

DESIGN

Cohort study with retrospective analysis of prospectively collected data.

SETTINGS

This study was conducted at a high-volume pelvic exenteration center.

PATIENTS

Those who underwent pelvic exenteration for anal squamous cell carcinoma between 1994 and 2022.

MAIN OUTCOME MEASURES

Local recurrence-free and overall survival, intraoperative and postoperative complication rates, R0 resection rate, and long-term quality-of-life outcomes.

RESULTS

Of 958 patients who underwent pelvic exenteration, 66 (6.9%) had anal squamous cell carcinoma. Thirty-two patients (48.5%) were male and the median age was 57 years (range, 31-79). Ten patients (15%) had primary anal squamous cell carcinoma, 49 (74%) had a recurrent tumor, and 7 (11%) had a re-recurrent tumor. Twenty-two patients (33%) and 16 patients (24%) had a major complication and unplanned return to the operating theater, respectively. Of the 62 patients who underwent pelvic exenteration with curative intent, 50 (81%) had R0 resection, and the 5-year overall and local recurrence-free survival rates were 41% and 37%, respectively. R0 resection was associated with a higher 5-year overall survival (50% vs 8%, p < 0.001). The mental health component scores and several individual quality-of-life domains presented improved trajectories postoperatively (all p values <0.05).

LIMITATIONS

The generalizability of the findings outside specialist pelvic exenteration centers may be limited.

CONCLUSIONS

Morbidity, long-term survival, and quality-of-life outcomes after pelvic exenteration for anal squamous cell carcinoma are comparable to published outcomes of pelvic exenteration for other tumor types.

EXENTERACIN PLVICA POR CARCINOMA EPIDERMOIDE DE ANO RESULTADOS ONCOLGICOS, DE MORBILIDAD Y DE CALIDAD DE VIDA

ANTECEDENTES:La cirugía de rescate es la única opción de tratamiento potencialmente curativa para el carcinoma de células escamosas del ano recurrente. Cuando están involucradas vísceras pélvicas, tejidos blandos y huesos adyacentes, puede ser necesaria una exenteración pélvica con una escisión perineal amplia para asegurar márgenes quirúrgicos claros y aumentar la probabilidad de supervivencia a largo plazo.OBJETIVO:Informar sobre los resultados oncológicos, de morbilidad y de calidad de vida de la exenteración pélvica por carcinoma anal de células escamosas.DISEÑO:Estudio de cohortes con análisis retrospectivo de datos recogidos prospectivamente.ENTORNO CLINICO:Este estudio se realizó en un centro de exenteración pélvica de alto volumen.PACIENTES:Aquellos que se sometieron a exenteración pélvica por carcinoma anal de células escamosas entre 1994 y 2022.PRINCIPALES MEDIDAS DE VALORACIÓN:Supervivencia global y libre de recidiva local, tasas de complicaciones intraoperatorias y posoperatorias, tasa de resección R0 y resultados de calidad de vida a largo plazo.RESULTADOS:De 958 pacientes que se sometieron a exenteración pélvica, 66 (6,9%) tenían carcinoma anal de células escamosas. 32 pacientes (48,5%) eran varones y la mediana de edad fue de 57 años (rango 31-79). 10 pacientes (15%) tenían carcinoma anal primario de células escamosas, 49 (74%) tenían un tumor recurrente y 7 (11%) tenían una segunda recurrencia. 22 (33%) y 16 pacientes (24%) tuvieron una complicación mayor y regreso no planificado al quirófano, respectivamente. De los 62 pacientes que se sometieron a una exenteración pélvica con intención curativa, 50 (81%) tuvieron una resección R0, las tasas de supervivencia global y libre de recidiva local a los 5 años fueron del 41% y el 37%, respectivamente. La resección R0 se asoció con una mayor supervivencia general a los 5 años (50% frente a 8%, p < 0,001). Las puntuaciones del componente de salud mental y varios dominios de calidad de vida individuales presentaron trayectorias mejoradas después de la operación (todos los valores de p < 0,05).LIMITACIONES:La generalización de los hallazgos fuera de los centros especializados en exenteración pélvica puede ser limitada.CONCLUSIONES:Los resultados de morbilidad, supervivencia a largo plazo y calidad de vida después de la EP para el carcinoma anal de células escamosas son comparables a los resultados publicados de la exenteración pélvica para otros tipos de tumores. (Traducción-Dr. Ingrid Melo ).

The use of an obstetric balloon as a pelvic spacer in preventing empty pelvis syndrome after total pelvic exenteration in rectal cancers - A prospective safety and efficacy study for the Bakri balloon

AIM

Empty pelvis syndrome (EPS) is a source of considerable morbidity following total pelvic exenteration. None of the available methods have been universally successful in mitigating this problem. The aim of this work was to evaluate the safety and efficacy of the obstetric Bakri balloon in preventing empty pelvis syndrome.

METHOD

This study was a combined prospective and retrospective study of all total pelvic exenterations for rectal cancers from a single institution performed between October 2013 and May 2022. Since December 2019 the Bakri balloon was used in all patients who provided consent. EPS within 90 days was the primary end point, and included bowel obstruction, pelvic collection and entero-perineal fistula. Comparison with those patients who did not have a Bakri balloon was performed.

RESULTS

Seventy-five patients with a Bakri balloon were compared with 96 patients without a balloon placed after pelvic exenteration. No patient experienced an untoward complication from balloon deployment. The incidence of EPS was 13.3% and 22.9% in the Bakri and no Bakri cohorts, respectively (p = 0.110). Every component of EPS was proportionally lower, without statistical significance. Based on point estimates, the number needed to treat to prevent EPS using the Bakri balloon was 10.

CONCLUSIONS

Use of the Bakri balloon was safe without serious adverse events. The incidence of EPS after total pelvic exenteration was not statistically different with the use of the Bakri balloon despite a 9.6% reduction. A larger comparative study is needed to evaluate the efficacy of the balloon.