Post-operative mobilisation and mobility outcomes after pelvic exenteration surgery for colorectal cancer

Total pelvic exenteration surgery varies in the level of resection performed and requirement for reconstructive surgery. This study aimed to describe the recovery of mobility in the post-operative period and how it varies according to the surgery performed.

A retrospective audit of 104 patients was conducted, reflecting surgery conducted over a 7-year period. Data was collected until hospital discharge. Mobility was measured using the Intensive Care Mobility Scale. Results were analysed based on three levels of perineal resection (pelvic exenteration without abdominoperineal resection; abdominoperineal resection without flap reconstruction; and with flap reconstruction).

Flap reconstruction resulted in a longer time to the first stand (median [interquartile range] = 4 [3, 7] days) compared to abdominoperineal resection without a flap (3 [2, 5]) and exenteration surgery without abdominoperineal resection (2 [2, 3], P = <0.001). Differences in mobility were still present at hospital discharge, with 15 (49%) patients with flap reconstruction, 26 (61%) with abdominoperineal resection without flap reconstruction and 27 (90%) patients without abdominoperineal resection able to walk independently (P = 0.012). Patients undergoing flap reconstruction were more often transferred for rehabilitation (n = 9, 29%) after a prolonged hospital stay (37 [30, 85] days). They were less frequently discharged home (n = 11, 36%) compared to patients with abdominoperineal resection without flap reconstruction (n = 24, 60%) or without abdominoperineal resection (n = 21, 70%, P = 0.019).

Reconstructive surgery was associated with lower levels of mobility at hospital discharge and discharge to a rehabilitation facility.