Prevention and management of complications in pelvic exenteration |
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| Affiliation: | 1. Department of Woman s and Child Health, Fondazione Policlinico Universitario “Agostino Gemelli”, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy (Drs. Bizzarri, Fagotti, Cappuccio, Gallotta, Scambia, and Vizzielli);2. Division of Gynecologic Oncology, University of Palermo, Palermo, Italy (Drs. Chiantera, and Catello Di Donna);3. Department of Obstetrics and Gynecology, University of Eastern Piedmont, Novara, Italy (Dr. Ercoli);4. Department of Woman and Child Health, Fondazione Policlinico Universitario “Agostino Gemelli”, IRCCS, Rome, Italy (Drs. Tortorella and Conte).;1. Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA;2. Department of Woman and Child Health, Fondazione Policlinico Universitairio A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy;3. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA;4. Department of Gynecology, European Institute of Oncology (IEO), Milan, Italy |
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| Abstract: | Pelvic exenteration is widely recognised as the gold standard of care for locally advanced tumours of the pelvis. Surgery in pursuit of curative resection comes at the cost of significant morbidity. Perioperative complications are commonplace with the majority managed without further surgical intervention.Boundaries of resection are expanding, resulting in increasing incidence of excision of major vascular structures and bone. Optimisation of patients is paramount prior to such significant surgical insult. Specialist centres with designated multidisciplinary teams should be used whenever possible. Addressing anaemia and nutrition play a significant role in prehabilitation. Intra-operatively consideration should be given to prevention of empty pelvis syndrome, perineal reconstruction, safe control of vascular structures and minimising risk of fistulae. Post-operative complications are common however employment of enhanced recovery protocols, minimally invasive surgery and opiate sparing analgesia protocols may in time lead to improvements for patients. Enteric fistulae and urine leak remain the most devastating and risk reduction strategies should be employed. Early recognition and aggressive management of complications is essential. |
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| Keywords: | Pelvic exenteration Surgical complications Empty pelvis syndrome Urine leak Pelvic malignancy |
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