Urological reconstruction after pelvic oncological surgery: A single institution experience.
BACKGROUND
In locally advanced pelvic malignancies, there is often involvement of urological organs, necessitating resection and reconstruction, which can be associated with significant complications.


METHODS
We retrospectively reviewed 20 patients undergoing urological reconstructions during pelvic oncological surgeries from January 2004 to December 2013. All patients had imaging-proven involvement of at least one urological organ preoperatively. Primary outcome was urological complication rate. Secondary outcomes were nonurological complication, recurrence rate, and overall survival.


RESULTS
Median age of presentation was 51 years. Six and 14 patients underwent resections for primary and secondary tumors, respectively. Colorectal tumors were the most common, followed by gynecological cancers. The ureter was the most common urological organ involved, followed by the bladder, prostate, and seminal vesicles. Reconstructive procedures included ileal and sigmoid conduits, ureteroneocystostomies, Boari flap, transureteroureterostomies (TUUs) and direct ureteroureterostomies. Six patients developed major urological complications, requiring endoscopic and surgical reinterventions. The follow-up time was 34 months. Thirteen patients developed recurrence, associated with higher tumor grade and lymphovascular invasion, and occurred at a median time of 10 months. These patients had an overall survival of 20 months, compared to 45 months in patients without recurrence.


CONCLUSIONS
Careful patient selection in pelvic oncological surgeries can significantly prolong survival. Recurrent tumors and greater intraoperative blood loss are associated with higher urological complications. A limited pelvic exenteration and lower radiation doses can reduce complication rates. If higher doses are necessary, conformal techniques and hyperfractionated radiotherapy should be explored. Urological reconstruction should be individualized, according to the extensiveness of urological involvement and exposure of radiation.
Department of Surgical Oncology, National Cancer Centre Singapore, Singapore. Electronic address: yuguangtan90@gmail.com.
Yu Guang
YG
Tan
Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.
Grace
G
Tan
Department of Radiation Oncology, National Cancer Centre Singapore, Singapore.
David
D
Tan
Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.
Claramae S
CS
Chia
Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.
Dun Yong
DY
Ang
Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.
Melissa C C
MCC
Teo
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D010385:Pelvic Exenteration; D010386:Pelvic Neoplasms / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D014571:Urologic Neoplasms / Q000401:mortality / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*