RECONSTRUCTION OF URINARY AND GASTROINTESTINAL TRACTS IN TOTAL PELVICEXENTERATION - EXPERIENCE AT COLUMBIA-PRESBYTERIAN-MEDICAL-CENTER

Objectives. To examine the effectiveness of and complications from tot al pelvic exenteration (TPE) with maintenance of urethral and anal sph incter function for locally invasive tumors of the pelvis. Methods. A retrospective review of 4 patients who have undergone TPE with urethra l and anal sphincter preservation at Columbia-Presbyterian Medical Cen ter in the last 2 years was performed with attention to perioperative morbidity and mortality, disease-free status, and need for further ope rative procedures. Results. Two patients had colorectal adenocarcinoma , 1 had squamous cell carcinoma of the cervix, and 1 had prostate sarc oma. All had urinary tract reconstruction with orthotopic neobladder c reation, and 3 of 4 had primary low rectal anastomoses for gastrointes tinal reconstruction. One patient underwent creation of a J rectal pou ch. One of 4 patients had received radiation therapy for the disease p rior to surgery. There was no operative or perioperative mortality. Tw o of 4 patients required reoperation, 1 in the immediate postoperative period for repair of a left ureteral stricture, and the other 13 mont hs postoperatively for repair of a rectal-neobladder fistula. With a m ean follow-up of 25 months (range, 21 to 43 months), 3 of 4 patients a re alive and free of disease. All living patients are continent of uri ne and 2 of 5 are continent of stool.Conclusions. Our experience confi rms that TPE can be effective in controlling a variety of locally adva nced pelvic tumors and can be performed in conjunction with simultaneo us genitourinary and gastrointestinal reconstruction with minimal morb idity.