Use of an ureteroileocecal appendicostomy urinary reservoir in patients with recurrent pelvic malignancies treated with radiation.
OBJECTIVE
Evaluation of a modified right colon urinary reservoir in a heavily radiated patient population undergoing pelvic exenteration.


METHODS
A retrospective chart review was performed on all patients with recurrent gynecologic, colorectal, and urological tumors who underwent total pelvic or anterior exenteration and urinary diversion from 3/01 to 7/03 using an ureteroileocecal appendicostomy urinary reservoir.


RESULTS
Fourteen patients were identified over the study interval. The mean age of the patients was 53 years (range, 22-78 years). All patients received external beam, intracavitary, or a combination of both radiation treatment modalities to the pelvis preoperatively. Eight patients received intraoperative radiation therapy (IORT) at a mean dose of 16.25 Gy (range, 12.5-17.5 Gy). The primary sites of disease were as follows: cervix, five; prostate, three; uterus, two; colon/rectum two; and one each for vulva and bladder. Complete stomal continence was achieved in all patients after a median follow-up of 10 months (range, 2-31 months). Two patients experienced a traumatic disruption of the stomal-skin anastomosis in the early postoperative period (postoperative days 7 and 14). One late complication related to the ureterointestinal anastomosis was observed and consisted of an anastomotic stricture managed conservatively. One patient experienced an entero-pouch fistula following re-exploration for an acute postoperative hemorrhage.


CONCLUSIONS
The early outcomes using the ureteroileocecal appendicostomy urinary reservoir in heavily radiated patients demonstrate the technical feasibility of this design as both minimal early stoma and ureterointestinal complications may occur. Longer postoperative follow-up will be required to address the late outcomes of this procedure and its ultimate use in this population.
Bochner
Bernard H
BH
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. bochnerb@mskcc.org
McCreath
Wayne A
WA
Aubey
Janice James
JJ
Levine
Douglas A
DA
Barakat
Richard R
RR
Abu-Rustum
Nadeem
N
Poynor
Elizabeth
E
Wong
Douglas
D
Chi
Dennis S
DS
D000138:Acidosis / Q000209:etiology; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D001065:Appendix / Q000601:surgery*; D002431:Cecostomy / Q000009:adverse effects / Q000379:methods; D003131:Combined Modality Therapy; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010385:Pelvic Exenteration / Q000009:adverse effects / Q000379:methods*; D010386:Pelvic Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*; D016476:Urinary Reservoirs, Continent
D003404:Creatinine