Colorectal function preservation in posterior and total supralevator exenteration for gynecologic malignancies: an 89-patient series.
OBJECTIVE
The objective of this study was to analyze our experience with colorectal function preservation at the time of pelvic exenteration.


METHODS
Between January 1980 and December 2001, 201 pelvic exenterations for gynecologic malignancies were performed in our hospital. Ninety-eight were supralevator exenterations and 89 were selected for this study because low colorectal anastomosis (LCRA) was performed. There were locally advanced or recurrent cancers including 50 cervical, 28 ovarian, 11 endometrial, and 3 vaginal malignancies and 5 pelvic sarcomas.


RESULTS
Thirty-nine patients (44%) had a history of previous irradiation. There were were 50 posterior and 39 total exenterations. A diverting stomy and/or pelvic filling were performed respectively in 44 (49.4%) and 26 (29%) cases. The postoperative mortality rate was 4.5% (4/89). Seventeen patients experienced a colorectal anastomotic fistula (AF). AF occurred significantly more frequently in irradiated patients (14/17 = 82%). The mortality rate related to AF was 6% (1/17). Ultimately the functional colorectal anastomosis rate was 71.9%, respectively 61.5 and 80% in irradiated and nonirradiated patients.


CONCLUSIONS
Colorectal function preservation in supralevator exenteration for gynecologic malignancies can be achieved safely in a majority of patients. In irradiated patients a systematically diverting stomy may result in a low mortality rate.
Moutardier
V
V
Institut J. Paoli-l Calmettes and Université de la Méditerranée, 232 Bd de Sainte Marguerite, 13009 Marseille, France. moutardiev@marseille.fnclcc.fr
Houvenaeghel
G
G
Lelong
B
B
Mokart
D
D
Delpero
J R
JR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D003106:Colon / Q000502:physiology / Q000601:surgery*; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D010385:Pelvic Exenteration / Q000009:adverse effects / Q000379:methods*; D012007:Rectum / Q000502:physiology / Q000601:surgery*; D012189:Retrospective Studies