Major complications following exenteration in cases of pelvic malignancy: a 10-year experience.
OBJECTIVE
To analyze the major complications after exenteration of gynecological and rectal malignancies.


METHODS
Twenty-two patients with gynecological malignancy and 6 with rectal malignancy underwent pelvic exenteration (PE) between 1996 and 2005. PE was performed for primary malignancy in 71.4% of cases (vulvar cancer in 13, cancer rectal in 5, cervical cancer in 1 and Bartholin's gland cancer in 1 cases respectively and recurrent malignancy in 28.6% of cases (cervical cancer in 5, ovarian cancer in 1, uterine sarcoma in 1 and rectal cancer in 1 cases respectively). Posterior PE, total PE and anterior PE were most often performed.


RESULTS
Major complications in the operative field involving the urinary tract infection or the wound dehiscence occurred in 12 patients (42.9%). Early complications included massive bleeding from the sacral plexus, adult respiratory distress syndrome (ARDS), thrombophlebitis, acute renal failure, urinary bladder dysfunction, ureter damage, re-operation and pulmonary embolus. Urinary incontinence was observed in 2 women as a late complication. In 1 patient a nephrostomy was performed in 1 patient due to extensive hydronephrosis and 1 patient had complications connected with the gastrointestinal tract. The mortality rate was 7%, of which inter-operative mortality accounted for 3.5%. Major complications often occurred in advanced primary vulvar cancer affecting those with recurrent malignancies.


CONCLUSIONS
PE is more beneficial to patients with primary vulvar and rectal cancer than to those with recurrent cancer. Knowledge of the inherent complications and morbidity of PE is essential.
Department of Gynecology of Medical University of Gdansk, 80-402 Gdansk ul. Kliniczna 1 A, Poland. dwydra@amg.gda.pl
Dariusz
D
Wydra
Janusz
J
Emerich
Sambor
S
Sawicki
Katarzyna
K
Ciach
Andrzej
A
Marciniak
D058186:Acute Kidney Injury / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D010385:Pelvic Exenteration / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D010386:Pelvic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D019106:Postoperative Hemorrhage / Q000209:etiology; D012004:Rectal Neoplasms / Q000601:surgery*; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000209:etiology