title: Urological leaks after pelvic exenterations comparing formation of colonic and ileal conduits.
abstract: BACKGROUND
  The aim of this study was to assess possible risk factors for urinary leakage of a newly formed urinary conduit after a partial or total pelvic exenteration.
  
  
  METHODS
  An analysis was conducted from prospectively collected data of patients who underwent a pelvic exenteration with conduit formation for advanced and recurrent pelvic cancer.
  
  
  RESULTS
  Of 232 patients undergoing a pelvic exenteration, 74 (32%) had a conduit formed. Of these, 47 (64%) had an ileal conduit compared with 27 (36%) a colonic conduit. Twelve (16%) patients developed a leak, of which nine occurred within the first month. Factors associated with a conduit leak included involvement of R2 surgical margins (43%), the magnitude of the exenteration and a current cardiovascular medical history (27%). Leaks were not found to be associated with either radiotherapy or chemotherapy. The 30-day leak rate for ileal conduits was 17% (8/47) and 4% (1/27) for colonic conduits with enterocutaneous fistula only occurring in the ileal conduit group (2/47). Fistula, drained collections and sepsis occurred in 40% of ileal and 19% of colonic conduits (p < 0.01). Patients with a conduit leak had a longer length of stay (59 versus 23 days, p < 0.001).
  
  
  CONCLUSIONS
  Urine leaks after conduit formation in association with exenterations are relatively common with a prolonged length of hospital stay. Positive surgical margins and exenterations involving all four quadrants of the pelvis were associated with higher leak rates. There was no evidence of a difference between ileal and colonic conduits and number of leaks. However colonic conduits had less total complications including sepsis, leak and pelvic collections with comparatively no complications of a small bowel fistula.
authors.affiliation: ErasmusMC, Rotterdam, The Netherlands.
authors.forename: S C
authors.initials: SC
authors.lastname: Teixeira
authors.forename: F T
authors.initials: FT
authors.lastname: Ferenschild
authors.forename: M J
authors.initials: MJ
authors.lastname: Solomon
authors.forename: L
authors.initials: L
authors.lastname: Rodwell
authors.forename: J D
authors.initials: JD
authors.lastname: Harrison
authors.forename: J M
authors.initials: JM
authors.lastname: Young
authors.forename: A
authors.initials: A
authors.lastname: Vasilaras
authors.forename: D
authors.initials: D
authors.lastname: Eisinger
authors.forename: P
authors.initials: P
authors.lastname: Lee
authors.forename: C
authors.initials: C
authors.lastname: Byrne
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000209:etiology*; D003106:Colon / Q000601:surgery; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D007082:Ileum / Q000601:surgery; D007412:Intestinal Fistula / Q000209:etiology; D007902:Length of Stay; D008297:Male; D009517:New South Wales; D010385:Pelvic Exenteration / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D016896:Treatment Outcome; D014547:Urinary Diversion / Q000379:methods*