Bony pelvic resection is a risk factor for pelvic abscess after total pelvic exenteration for pelvic malignancies

Pelvic abscess (PA) is a serious complication of pelvic exenteration (PE) that adversely affects patient outcomes. Although various procedures, including flap reconstruction, have been challenged, definitive indications have not been established. This study aims to identify the risk factors for PA following total PE (TPE).

The subjects of this retrospective study were 107 consecutive patients who underwent TPE for locally advanced or recurrent pelvic tumors between June, 2006 and July, 2019. We analyzed the perioperative risk factors for PA, defined as infectious fluid collection in the deep pelvis requiring drainage.

PA developed in 37 patients (34.6%), whose postoperative hospital stay was significantly longer than that of patients without PA (53 days vs. 32 days, P < 0.01). Among the presurgical and surgical factors, bony pelvic resection was an independent predictor of PA (OR: 4.94; 95% CI: 1.57-15.54; P = 0.01). Computed tomography (CT) findings of fluid accumulation and the absence of small intestine in the deep pelvis correlated significantly with PA incidence (P = 0.02, respectively).

Bony pelvic resection is a key risk factor for PA following TPE. Consequently, filling the pelvic dead space with a myocutaneous flap could be considered to reduce the risk of PA in patients undergoing bony pelvic resection.