Prevention of complications following pelvic exenteration with the use of mammary implants in the pelvic cavity: Technique and results of 28 cases

Abstract

Background: With the evolution of neo-adjuvant therapy and the introduction of peritonectomy with chemotherapy in surgical practice, pelvic exenteration has taken second place in the treatment of advanced pelvic tumors. This surgery remains the first of choice for the treatment of T4 superior and medium rectal tumors that are not susceptible to neo-adjuvant radiochemotherapy, for uterine tumors and cervical FIGO IV T4, for pelvic recurrence and for T4 bladder tumors. After a pelvic exenteration the pelvic cavity becomes occupied by the intestinal loops, causing an increase in the risk of short and long-term complications such as radiation enteritis in the case of post-operative radiotherapy, occlusions, and enteric fistulas that could be avoided by isolating the small intestine in the pelvic cavity.

Methods: With this aim we positioned a mammary prosthesis (implant) in the cavity of the last 28 cases we treated, and did not observe complications related to the prosthetic implant.

Results: No early or delayed complications, such as occlusions or fistulas, were observed. All the patients treated underwent adjuvant radiotherapy with no evidence of radiation enteritis. Ten patients were recanalized with removal of the implant, ultra-low rectal anastomosis was performed in six cases and colo-anal anastomosis was performed in four cases. Eight patients were not recanalized, six distance due to recurrence and two local recurrence. Nine patients are currently in follow-up, disease free between 1 and 12 months.

Conclusions: We retain the encouraging results observed that the use of mammary implants in the pelvic cavity after pelvic exenteration should be part of the cultural patrimony of the surgeon who approaches this type of major radical surgery.