Oliver Peacock1, Peadar S Waters2, Joseph C Kong2, Satish K Warrier2, Chris Wakeman3, Tim Eglinton3, Declan G Murphy4, Alexander G Heriot2, Frank A Frizelle3, Jacob J McCormick2. 1. Colorectal Division of Cancer Surgery, Peter MacCallum Cancer Centre, 350 Grattan Street, Melbourne, VIC, 3000, Australia. oliver.peacock@nhs.net. 2. Colorectal Division of Cancer Surgery, Peter MacCallum Cancer Centre, 350 Grattan Street, Melbourne, VIC, 3000, Australia. 3. Colorectal Surgery Unit, Christchurch Hospital, Christchurch, New Zealand. 4. Urology Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.
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.
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.
Authors: Niall F Davis; John P Burke; Ted McDermott; Robert Flynn; Rustom P Manecksha; John A Thornhill Journal: Can Urol Assoc J Date: 2015 May-Jun Impact factor: 1.862
Authors: Cherng Huei Kong; Glenn D Guest; Douglas A Stupart; Ian G Faragher; Steven T F Chan; David A Watters Journal: ANZ J Surg Date: 2015-03-30 Impact factor: 1.872
Authors: O Peacock; P S Waters; M Bressel; A C Lynch; C Wakeman; T Eglinton; C E Koh; P J Lee; K K Austin; S K Warrier; M J Solomon; F A Frizelle; A G Heriot Journal: Br J Surg Date: 2019-07-24 Impact factor: 6.939
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