Morbidity and mortality after pelvic exenteration for colorectal adenocarcinoma

A retrospective analysis was made of the complications from pelvic exenterations performed over the past 30 years for colorectal adenocarcinoma at the Roswell Park Cancer Institute. Seventy-five patients underwent exenteration, 51 for primary disease (PD) and 24 for recurrent disease (RD). Both total and posterior exenterations were included. Twenty of the fifty-one patients (39%) undergoing exenteration for PD developed severe complications, with an operative mortality rate of 6%. The most common complications were injuries to the ureter or bladder, intra-abdominal abscesses, and anastomotic leaks from the urinary diversion. After exenteration for RD, 12 of 24 patients (50%) developed severe complications, with an operative mortality rate of 4%. The most common major complication was an anastomotic leak from the urinary diversion; this occurred in 33% of all patients with RD (8/24). The authors conclude that, although exenteration for colorectal adenocarcinoma may be performed with a low operative mortality rate, patients must be carefully selected because the associated morbidity rate remains high.