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Complications and 5-year survival after radical resections which include urological organs for locally advanced and recurrent pelvic malignancies: analysis of 646 consecutive cases

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Abstract

Background

Extensive multi-visceral resection, including components of the urinary tract, is often required to achieve clear resection margins, which is now well established as a key predictor of long-term survival for locally advanced pelvic tumours. The aims of this study were to analyse major morbidity and factors predicting complications and long-term outcomes following a urological procedure within extended radical resections.

Methods

Data were collected from prospective databases at two high-volume institutions specialising in extended radical resections for locally advanced and recurrent pelvic malignancies between 1990 and 2015. The primary endpoints were general major complications (Clavien–Dindo ≥ 3) and factors influencing complications and overall survival after urological resection.

Results

A total of 646 consecutive patients requiring an extended radical resection for locally advanced or recurrent pelvic malignancies were identified. The median age was 63 years (range 19–89 years) and the majority were female (371; 57.4%). A urological resection was performed as part of the resection in 226 patients (35.0%). The overall 30-day major complication rate was significantly higher in the urological intervention group (23%; n = 52) compared to the non-urological group (12.9%; n = 54 patients; p = 0.001). Intestinal anastomotic leak (p = 0.001) and intra-abdominal collections (p = 0.001) were more common in the urological cohort. Ileal conduit formation was an independent predictor of major morbidity (OR 1.95; 95% CI 1.24–3.07; p = 0.004). Independent prognostic markers for poor 5-year survival following urological procedures were recurrent tumour, cardiovascular disease, previous thromboembolic event and postoperative pulmonary embolism.

Conclusions

Extended radical resections which include a urological resection are associated with significantly more major morbidity than those without urological resection. Ileal conduit formation is independently associated with the development of major morbidity. Five-year overall survival is no different for patients who had or did not have urological resection as part of extended radical surgery for locally advanced or recurrent pelvic malignancy.

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Authors and Affiliations

  1. Colorectal Division of Cancer Surgery, Peter MacCallum Cancer Centre, 350 Grattan Street, Melbourne, VIC, 3000, Australia

    Oliver Peacock, Peadar S. Waters, Joseph C. Kong, Satish K. Warrier, Alexander G. Heriot & Jacob J. McCormick

  2. Urology Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia

    Declan G. Murphy

  3. Colorectal Surgery Unit, Christchurch Hospital, Christchurch, New Zealand

    Chris Wakeman, Tim Eglinton & Frank A. Frizelle

Authors
  1. Oliver Peacock
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  2. Peadar S. Waters
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  3. Joseph C. Kong
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  4. Satish K. Warrier
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Correspondence to Oliver Peacock.

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The study was approved by the Peter MacCallum Cancer Centre Human Research Ethics Committee (HREC 14/68R).

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10151_2019_2141_MOESM1_ESM.tif

Supplementary file1 Appendix 1: Five-year overall survival of patients who had urological and non-urological interventions (TIF 646 kb)

10151_2019_2141_MOESM2_ESM.tif

Supplementary file2 Appendix 2: Five-year overall survival of patients with primary versus recurrent disease in the urological intervention group (TIF 741 kb)

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Peacock, O., Waters, P.S., Kong, J.C. et al. Complications and 5-year survival after radical resections which include urological organs for locally advanced and recurrent pelvic malignancies: analysis of 646 consecutive cases. Tech Coloproctol 24, 181–190 (2020). https://doi.org/10.1007/s10151-019-02141-4

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  • DOI: https://doi.org/10.1007/s10151-019-02141-4

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