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Surgeons Corner
Low Colorectal Anastomosis After Pelvic Exenteration for Gynecologic Malignancies: Risk Factors Analysis for Leakage
  1. Matías Jurado, MD*,
  2. Juan Luis Alcazar, MD*,
  3. Jorge Baixauli, MD† and
  4. Jose Luis Hernandez-Lizoain, MD‡
  1. * Department of Gynecology and
  2. † Gastrointestinal Surgery Division, Clínica Universitaria, University of Navarra, School of Medicine, Pamplona, Spain.
  3. ‡ Gastrointestinal Surgery Division, Clínica Universitaria, University of Navarra, School of Medicine, Pamplona, Spain.
  1. Address correspondence and reprint requests to Matias Jurado, MD, Department of Gynecology, Clínica Universitaria, University of Navarra, Avenida Pio XII, 36 31008 Pamplona, Spain. E-mail: mjurado{at}unav.es.

Abstract

Objective: To study risk factors for low colorectal anastomotic leak after pelvic exenteration for gynecologic malignancies.

Methods: Data from 60 patients, 32 with ovarian cancer and 28 with nonovarian cancer who underwent pelvic exenteration with colorectal anastomosis (CRA) were retrospectively analyzed.

Results: Overall rate of CRA leak was 20%. The CRA leak was associated with type of tumor (3% for the ovarian cancer and 40.8% for the nonovarian cancer, P = 0.004), CRA height (<5 cm vs ≥5 cm, 75% vs 6.3%; P = 0.001), and previous radiotherapy (RT; 53.3% vs 8.9%; P = 0.001). Multivariate analysis showed that only previous RT and CRA height were associated with the CRA leak. Rectosigmoid wall involvement (81.8% vs 27%; P = 0.001) and mesorectum infiltration (69.2% vs 21.7%; P = 0.001) were more frequent among patients with ovarian cancer patients.

Conclusion: Previous RT and CRA at or less than 5 cm from the anal verge pose a high risk for CRA leak. In these cases, a definitive colostomy should be recommended.

  • Pelvic exenteration
  • Gynecological cancer
  • Colorectal anastomosis
  • Morbidity

https://doi.org/10.1097/IGC.0b013e31820b2df7

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