Pelvic intraoperative iatrogenic oncosurgical injuries: single-center experience

Iatrogenic events are more likely to occur during surgical treatment of malignant conditions. Gynecologic and colorectal cancers account for most of the cases that require surgical treatment within the pelvic area. The purpose of this study was to analyze the incidence of intraoperative accidents and the most frequently encountered injuries during surgery for cancers of the pelvic area.

The records of 2702 patients admitted to our clinic over a 15-year period, (January 2000-December 2014), were analyzed for type and frequency of intraoperative accidents.

Urinary tract lesions were the most common injuries seen in this series (63.1%), followed by enteral (28.1%) and vascular (8.8%) injuries, with an overall incidence of 2.9% for the whole group. Iatrogenic injuries showed a statistically significant difference in incidence depending on the type of primary malignancy (p<0.002). Cervical cancer was associated with a higher rate of ureteral lesions, whereas enteral injuries occurred predominantly during surgical resection for ovarian cancer. The use of neoadjuvant radiotherapy or chemotherapy has been associated with a significantly lower risk of surgical iatrogenic injuries (p=0.004).

Immediate recognition of the lesion and prompt treatment are recommended in order to lower postoperative complications and to avoid a second operation.