Laparotomy After Total Pelvic Exenteration: Current Status and Techniques for Ileal Conduit Preservation

Background/Aim: Advances in chemotherapy have shifted the treatment paradigm for colorectal cancer from surgical intervention to medical treatment. We report the outcomes of laparotomy following total pelvic exenteration (TPE) and describe specific methods for preventing ileal conduit injury.

Patients and Methods: Eighteen patients underwent a total of 29 laparotomies after TPE. Laparotomies were categorized into three types “Recurrence surgery”, “Complication surgery (early complications and late complications)”, and “Palliative surgery”. Ileal conduit preservations were categorized into Category A (Retrograde catheterization), Category B (Internal stenting via nephrostomy), and Category C (Sustained stenting after TPE).

Results: Among the seven recurrence surgeries, four (57.1%) involved tumor resection with ostectomy and three (42.9%) involved tumor resection alone. Among the seven early complication surgeries, colostomy and drainage for peritonitis due to perforation was the most common procedure (3/7, 42.9%). Among the eight late complication surgeries, ileal conduit reconstruction was most common (3/8, 37.5%). Among the seven palliative surgeries, bypass surgery was the most frequent procedure (5/7, 71.4%). The distribution of ileal conduit preservation strategies differed significantly according to surgery type: recurrence surgery, Category A 28.6%, Category B 28.6%, none 42.8%; early complication surgery, Category C 100.0%; late complication surgery, Category A 37.5%, Category B 50.0%, none 12.5%; and palliative surgery, Category B 14.3%, Category C 14.3%, none 71.4% (p<0.0001).

Conclusion: Laparotomy after TPE appears to be a feasible and acceptably safe option when performed with appropriate precautions, particularly with strategies aimed at preserving the ileal conduit.