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World J Gastroenterol. Feb 21, 2006; 12(7): 1115-1119
Published online Feb 21, 2006. doi: 10.3748/wjg.v12.i7.1115
Major complications following exenteration in cases of pelvic malignancy: A 10-year experience
Dariusz Wydra, Janusz Emerich, Sambor Sawicki, Katarzyna Ciach, Andrzej Marciniak
Dariusz Wydra, Janusz Emerich, Sambor Sawicki, Katarzyna Ciach, Department of Gynecology of Medical University of Gdansk, Poland
Andrzej Marciniak, Department of Anesthesiology of Medical University of Gdansk, Poland
Correspondence to: Dariusz Wydra MD, PhD, Department of Gynecology of Medical University of Gdansk, 80-402 Gdańsk ul. Kliniczna 1 A Poland. dwydra@amg.gda.pl
Telephone: + 48-509-905500 Fax: + 48-58-3418003
Received: August 16, 2005
Revised: September 2, 2005
Accepted: September 12, 2005
Published online: February 21, 2006

AIM: To analyze the major complications after exenteration of gynecological and rectal malignancies.

METHODS: Twenty-two patients with gynecological malignancy and 6 with rectal malignancy underwent pelvic exenteration (PE) between 1996 and 2005. PE was performed for primary malignancy in 71.4% of cases (vulvar cancer in 13, cancer rectal in 5, cervical cancer in 1 and Bartholin’s gland cancer in 1 cases respectively and recurrent malignancy in 28.6% of cases (cervical cancer in 5, ovarian cancer in 1, uterine sarcoma in 1 and rectal cancer in 1 cases respectively). Posterior PE, total PE and anterior PE were most often performed.

RESULTS: Major complications in the operative field involving the urinary tract infection or the wound dehiscence occurred in 12 patients (42.9%). Early complications included massive bleeding from the sacral plexus, adult respiratory distress syndrome (ARDS), thrombophlebitis, acute renal failure, urinary bladder dysfunction, ureter damage, re-operation and pulmonary embolus. Urinary incontinence was observed in 2 women as a late complication. In 1 patient a nephrostomy was performed in 1 patient due to extensive hydronephrosis and 1 patient had complications connected with the gastrointestinal tract. The mortality rate was 7%, of which inter-operative mortality accounted for 3.5%. Major complications often occurred in advanced primary vulvar cancer affecting those with recurrent malignancies.

CONCLUSION: PE is more beneficial to patients with primary vulvar and rectal cancer than to those with recurrent cancer. Knowledge of the inherent complications and morbidity of PE is essential.

Keywords: Complications, Pelvic exenteration, Gynacological cancer, Rectal cancer, Vulvar cancer