title: [Urinary complications of pelvic exenterations for rectal cancer with urinary invasion].
abstract: OBJECTIVE
  Pelvic exenteration for rectal cancer is indicated in locally advanced rectal tumors or pelvic recurrence invading adjacent organs. The oncologic goal being a complete R0 resection. Our aim was to study the urinary complications resulting from pelvic exenterations with urinary reconstruction in order to obtain a complete local control of the disease.
  
  
  METHODS
  Between April 2004 and June 2013, 42 patients who underwent pelvic exenteration for primary or recurrent rectal adenocarcinoma with urinary tract reconstruction were included. The urinary reconstruction was performed based on preoperative imaging and intraoperative findings. We studied early (within 30 postoperative days) and late urinary morbidity, as well as postoperative carcinologic control.
  
  
  RESULTS
  Forty-two exenterations were performed for primary rectal cancer (n=15) or pelvic recurrence (n=27). R0 complete resection was achieved in 64% of patients. The resection was incomplete (R1) on the urinary tract in 9.5% of patients. The urinary reconstruction methods used were: 31 transileal ureterostomies after total exenteration (bricker procedure), 6 ureteral reimplantations on psoic bladder, 2 ureteroileoplasties, 2 partial cystectomies and one ureteral resection with simple ligation. The median follow-up was 20 months. The perioperative mortality was 2.3% (n=1) and postoperative overall morbidity was 64%. Early and late urinary morbidity was 23.8% and 21.4% respectively. Six patients developed major urinary complications (≥ Clavien IIIb).
  
  
  CONCLUSIONS
  Pelvic exenteration with urinary resection resulted in our experience, in a local disease control of 64% (including a 90.5% for the urinary tract) at the price of an acceptable early specific morbidity and a low mortality that seems to justify an aggressive surgical approach.
authors: Département d'urologie, d'andrologie et de transplantation rénale, CHU Toulouse Rangueil, 1, avenue du Pr-Jean-Poulhes, 31000 Toulouse, France. Electronic address: jeromegas@hotmail.fr.
authors: J
authors: J
authors: Gas
authors: Département d'urologie, d'andrologie et de transplantation rénale, CHU Toulouse Rangueil, 1, avenue du Pr-Jean-Poulhes, 31000 Toulouse, France.
authors: J B
authors: JB
authors: Beauval
authors: Département de chirurgie digestive et oncologique, CHU Toulouse Purpan, place du Docteur Baylac, 31059 Toulouse, France.
authors: M
authors: M
authors: Chalret du Rieu
authors: Département d'urologie, d'andrologie et de transplantation rénale, CHU Toulouse Rangueil, 1, avenue du Pr-Jean-Poulhes, 31000 Toulouse, France.
authors: E
authors: E
authors: Bou Nasr
authors: Département de chirurgie digestive et oncologique, CHU Toulouse Purpan, place du Docteur Baylac, 31059 Toulouse, France.
authors: A
authors: A
authors: Philis
authors: Département de chirurgie digestive et oncologique, CHU Toulouse Purpan, place du Docteur Baylac, 31059 Toulouse, France.
authors: S
authors: S
authors: Kirzin
authors: Département d'urologie, d'andrologie et de transplantation rénale, CHU Toulouse Rangueil, 1, avenue du Pr-Jean-Poulhes, 31000 Toulouse, France.
authors: M
authors: M
authors: Thoulouzan
authors: Département d'urologie, d'andrologie et de transplantation rénale, CHU Toulouse Rangueil, 1, avenue du Pr-Jean-Poulhes, 31000 Toulouse, France.
authors: M
authors: M
authors: Soulié
authors: Département de chirurgie digestive et oncologique, CHU Toulouse Purpan, place du Docteur Baylac, 31059 Toulouse, France.
authors: L
authors: L
authors: Ghouti
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010385:Pelvic Exenteration / Q000009:adverse effects*; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D014570:Urologic Diseases / Q000209:etiology* / Q000601:surgery*; D014571:Urologic Neoplasms / Q000473:pathology*; D013520:Urologic Surgical Procedures
keywords: Cancer rectal; Carcinologic control; Complications urinaires; Exentération pelvienne; Facteurs de risque; Local recurrence; Pelvic exenteration; Rectal cancer; Risk factor; Récidive locale; Urinary tract complication