title: Efficacy of an additional flap operation in bladder-preserving surgery with radical prostatectomy and cystourethral anastomosis for rectal cancer involving the prostate.
abstract: OBJECTIVE
  Sphincter-preserving operations performed with bladder-preserving surgery and a cystourethral anastomosis (CUA) do not require a urinary stoma, but leakage from the CUA may develop. The aim of this study was to evaluate the efficacy of performing an additional flap operation.
  
  
  METHODS
  The subjects were 39 patients who underwent bladder-preserving surgery for advanced rectal cancer involving the prostate, between 2001 and 2015.32 of whom had a CUA and one of whom had a neobladder. Five of these 32 patients underwent an ileal flap operation, 2 underwent an omental flap operation, and 3 underwent an operation using both flaps.
  
  
  RESULTS
  Leakage developed in 3 (30%) of the 10 patients who underwent additional flap operations, but in 14 (60.9%) of the 23 patients who did not undergo a flap operation. The mean periods of catheterization for the patients who suffered leakage were 31 weeks (8-108 weeks) in those without a flap and 16 weeks (8-20 weeks) in those with a flap. Four (33.3%) of the 12 patients with leakage after surgery without a flap had a period of urinary catheterization >30 weeks, and 2 (16.7%) had leakage of CTCAE grade 3. There were no cases of leakage after flap surgery.
  
  
  CONCLUSIONS
  An additional flap operation may decrease the risk of leakage from a CUA.
authors.affiliation: Department of Colorectal and Pelvic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-City, Chiba, 277-8577, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Noguchi
authors.affiliation: Department of Colorectal and Pelvic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-City, Chiba, 277-8577, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nishizawa
authors.affiliation: Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Komai
authors.affiliation: Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Sakai
authors.affiliation: Department of Colorectal and Pelvic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-City, Chiba, 277-8577, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kobayasi
authors.affiliation: Department of Colorectal and Pelvic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-City, Chiba, 277-8577, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ito
authors.affiliation: Department of Colorectal and Pelvic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-City, Chiba, 277-8577, Japan. norsaito@east.ncc.go.jp.
authors.forename: Norio
authors.initials: N
authors.lastname: Saito
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D057868:Anastomotic Leak / Q000517:prevention & control*; D015179:Colorectal Neoplasms / Q000601:surgery*; D006801:Humans; D007082:Ileum / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D012306:Risk; D013524:Surgical Flaps; D013997:Time Factors; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*
keywords: Additional flap operation; Bladder-preserving surgery; Colorectal cancer; Total pelvic excision