Outcomes of colorectal anastomoses during pelvic exenteration for gynaecological malignancy

Although pelvic exenteration is frequently indicated during surgery for gynaecological malignancy, performing a colorectal anastomosis remains contentious because of concern about leakage. This study evaluated the safety of performing a low colorectal anastomosis during pelvic exenteration for gynaecological malignancy.

Between April 2001 and December 2006, 145 consecutive patients underwent low colorectal anastomosis without (122) or with (23) a stoma after pelvic exenteration for advanced primary or recurrent gynaecological malignancy. Subjects were assessed in terms of five patient-, four disease- and two surgery-related variables. The proportion of patients with each risk factor for leakage was found, and the rate of symptomatic anastomotic leakage was determined.

The mean age of the patients was 53.5 (range 10-77) years and the most common diagnosis was ovarian cancer (77.9 per cent). The mean operating time was 453 (range 145-845) min and the mean blood loss was 1080 (range 110-10 500) ml; 95 patients (65.5 per cent) required a blood transfusion. Of the 145 patients, 81 (55.9 per cent) had patient-related, 94 (64.8 per cent) had disease-related and 67 (46.2 per cent) had surgery-related variables associated with a risk of leakage. Symptomatic anastomotic leakage developed in three patients (2.1 per cent).

Although patients with gynaecological malignancy carry considerable risks associated with anastomotic leakage, carefully executed low colorectal anastomosis during pelvic exenteration was found to be safe.