RECTAL INJURY IN RADICAL PROSTATECTOMIES FOR CANCER - THE 1994 ANFUC SURVEY

This survey was conducted by 28 urologists members of the ANFUC who re ported rectal wounds observed during radical prostatectomy procedures performed for cancer. There were 1.816 procedures reported: 1.785 supr apubic prostatectomies and 28 perineal operations. Kraske access was u sed in 3 cases. There were 33 wounds to the rectum reported by 17 oper ators including 31 in suprapubic prostatectomies (1.7% of the operatio ns) and 2 after transperineal operations (7.14%). Preoperative radioth erapy was never used and mechanical preparation was performed in most of the cases with rectal complications (27/33). The wound was sutured in all cases and a colonic derivation was required in 4. Retrospective ly this procedure was judged unnecessary in 2 or 3 cases. The post-ope rative period was uneventful in all cases and the derivations were clo sed 2 or 3 months later. The conclusions drawn from this survey were t he following: the rate of rectal complications in radical prostatectom y is higher in the perineal route. When no preoperative radiotherapy h as been performed, simple suture of the rectal wound is sufficient and colonic derivation is not always necessary. It does not appear necess ary to interpose an epiploic flap in such cases which would have the d isadvantage of requiring opening the peritoneal cavity. These consider ations are only applicable to the nonirradiated rectum. Preoperative r adiotherapy would undoubtedly have a major effect, but we have had no experience in this series.