Top

International Journal of Colorectal Disease

Published in:

Open Access 01-12-2024 | RESEARCH

Evaluating postoperative hernia incidence and risk factors following pelvic exenteration

Authors: Nicole Anais Milanko, Michael Eamon Kelly, Greg Turner, Joeseph Kong, Cori Behrenbruch, Helen Mohan, Glen Guerra, Satish Warrier, Jacob McCormick, Alexander Heriot

Published in: International Journal of Colorectal Disease | Issue 1/2024

Abstract

Pelvic exenteration (PE) is a technically challenging surgical procedure. More recently, quality of life and survivorship following PEs are being increasingly acknowledged as important patient outcomes. This includes evaluating major long-term complications such as hernias, defined as the protrusion of internal organs through a facial defect (The PelvEx Collaborative in Br J Surg 109:1251–1263, 2022), for which there is currently limited literature. The aim of this paper is to ascertain the incidence and risk factors for postoperative hernia formation among our PE cohort managed at a quaternary centre.

Method

A retrospective cohort study examining hernia formation following PE for locally advanced rectal carcinoma and locally recurrent rectal carcinoma between June 2010 and August 2022 at a quaternary cancer centre was performed. Baseline data evaluating patient characteristics, surgical techniques and outcomes was collated among a PE cohort of 243 patients. Postoperative hernia incidence was evaluated via independent radiological screening and clinical examination.

Results

A total of 79 patients (32.5%) were identified as having developed a hernia. Expectantly, those undergoing flap reconstruction had a lower incidence of postoperative hernias. Of the 79 patients who developed postoperative hernias, 16.5% reported symptoms with the most common symptom reported being pain. Reintervention was required in 18 patients (23%), all of which were operative.

Conclusion

This study found over one-third of PE patients developed a hernia postoperatively. This paper highlights the importance of careful perioperative planning and optimization of patients to minimize morbidity.

Available only for authorised users

The PelvEx Collaborative (2022) Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline. Br J Surg 109:1251–1263. https://doi.org/10.1093/bjs/znac317CrossRef

Pleth Nielsen C, Sorensen M, Christensen H, Funder J (2022) Complications and survival after total pelvic exenteration. Eur J Surg Oncol 48:1362–1367. https://doi.org/10.1016/j.ejso.2021.12.472CrossRefPubMed

Brunschwig A (1948) Complete excision of pelvic viscera for advanced carcinoma; a one-stage abdominoperineal operation with end colostomy and bilateral ureteral implantation into the colon above the colostomy. Cancer 1:177–183. https://doi.org/10.1002/1097-0142(194807)1:2%3c177::aid-cncr2820010203%3e3.0.co;2-aCrossRefPubMed

The PelvEx Collaborative (2018) Factors affecting outcomes following pelvic exenteration for locally recurrent rectal cancer. Br J Surg 105:650–657. https://doi.org/10.1002/bjs.10734CrossRef

Heger U, Koch M, Buchler M, Weitz J (2010) Total pelvic exenteration. Chirurg 81:897–901. https://doi.org/10.1007/s00104-010-1945-zCrossRefPubMed

Boland P, Kelly M (2022) Advanced colorectal cancer: redefining the outcome paradigm; balancing cure with quality of life. Colorectal Dis 24:155–156. https://doi.org/10.1111/codi.15950CrossRefPubMed

The PelvEx Collaborative (2022) Contemporary management of locally advanced and recurrent rectal cancer: views from the PelvEx Collaborative. Cancers (Basel). https://doi.org/10.3390/cancers14051161CrossRef

Milne T, Solomon M, Lee P, Young J, Stalley P, Harrison J (2013) Assessing the impact of a sacral resection on morbidity and survival after extended radical surgery for locally recurrent rectal cancer. Ann Surg 258:1007–1013. https://doi.org/10.1097/sla.0b013e318283a5b6CrossRefPubMed

Venchiarutti R, Solomon M, Koh C, Young J, Steffens D (2019) Pushing the boundaries of pelvic exenteration by maintaining survival at the cost of morbidity. Br J Surg 106:1393–1403. https://doi.org/10.1002/bjs.11203CrossRefPubMed

10.

Pawlik T, Skibber J, Rodriguez-Bigas M (2006) Pelvic exenteration for advanced pelvic malignancies. Ann Surg Oncol 13:612–623. https://doi.org/10.1245/aso.2006.03.082CrossRefPubMed

11.

The PelvEx Collaborative (2019) Surgical and survival outcomes following pelvic exenteration for locally advanced primary rectal cancer: results from an international collaboration. Ann Surg 269:315–321. https://doi.org/10.1097/sla.0000000000002528CrossRef

12.

Bhangu A, Ali S, Brown G, Nicholls R, Tekkis P (2014) Indications and outcome of pelvic exenteration for locally advanced primary and recurrent rectal cancer. Ann Surg 259:315–322. https://doi.org/10.1097/sla.0b013e31828a0d22CrossRefPubMed

13.

The PelvEx Collaborative (2019) Pelvic exenteration for advanced nonrectal pelvic malignancy. Ann Surg 270:899–905. https://doi.org/10.1097/SLA.0000000000003533CrossRef

14.

Harris C, Solomon M, Heriot A, Sagar P, Tekkis P, Dixon L, Pascoe R, Dobbs B, Frampton C, Harji D, Kontovounisios C, Austin K, Koh C, Lee P, Lynch A, Warrier S, Frizelle F (2016) The outcomes and patterns of treatment failure after surgery for locally recurrent rectal cancer. Ann Surg 264:323–329. https://doi.org/10.1097/sla.0000000000001524CrossRefPubMed

15.

The PelvEx Collaborative (2019) Changing outcomes following pelvic exenteration for locally advanced and recurrent rectal cancer. BJS Open 3:516–520. https://doi.org/10.1002/bjs5.50153CrossRef

16.

Palmer G, Martling A, Cedermark B, Holm T (2007) A population-based study on the management and outcome in patients with locally recurrent rectal cancer. Ann Surg Oncol 14:447–454. https://doi.org/10.1245/s10434-006-9256-9CrossRefPubMed

17.

Tortorella L, Casarin J, Mara K, Weaver A, Multinu F, Glaser G, Cliby W, Scambia G, Mariani A, Kumar A (2019) Prediction of short-term surgical complications in women undergoing pelvic exenteration for gynecological malignancies. Gynecol Oncol 152:151–156. https://doi.org/10.1016/j.ygyno.2018.10.036CrossRefPubMed

18.

Camilleri-Brennan J, Steele R (2001) The impact of recurrent rectal cancer on quality of life. Eur J Surg Oncol 27:349–353. https://doi.org/10.1053/ejso.2001.1115CrossRefPubMed

19.

Kim E, Fernando C, McCombie A, Bailey W, Frizelle F, Glyn T, Porter C, Wakeman C, Creagh T (2022) Abdominal and perineal hernia rates following vertical rectus abdominis myocutaneous (VRAM) flap reconstruction - a supraregional experience. J Plast Reconstr Aesthet Surg 75:1158–1163. https://doi.org/10.1016/j.bjps.2021.11.002CrossRefPubMed

20.

Nielsen M, Rasmussen P, Lindegaard J, Laurberg S (2012) A 10-year experience of total pelvic exenteration for primary advanced and locally recurrent rectal cancer based on a prospective database. Colorectal Dis 14:1076–1083. https://doi.org/10.1111/j.1463-1318.2011.02893.xCrossRefPubMed

21.

Heriot A, Kumar (2000) Rectal cancer recurrence: factors and mechanisms. Colorectal Dis 2:126–136. https://doi.org/10.1046/j.1463-1318.2000.00148.xCrossRefPubMed

22.

Chokshi R, Kuhrt M, Arrese D, Martin EJ (2013) Reconstruction of total pelvic exenteration defects with rectus abdominus myocutaneous flaps versus primary closure. Am J Surg 205:64–70. https://doi.org/10.1016/j.amjsurg.2012.04.010CrossRefPubMed

23.

Waters P, Peacock O, Warrier S, Wakeman C, Eglinton T, Lynch A, Frizelle F, Heriot A, McCormick J (2019) Evolution of pelvic exenteration surgery– resectional trends and survival outcomes over three decades. Eur J Surg Oncol 45:2325–2333. https://doi.org/10.1016/j.ejso.2019.07.015CrossRefPubMed

24.

Chauhan A, Morrison E, Lonie S, Sham E, Heriot A (2020) The inferior gluteal artery myocutaneous flap is preferable for reconstructing the complex perineal defect following pelvic exenteration. Plast Reconstr Surg 8:73–74. https://doi.org/10.1097/2F01.GOX.0000720672.09757.beCrossRef

25.

Alizai P, Andert A, Lelaona E, Neumann U, Klink C, Jansen M (2017) Impact of obesity on postoperative complications after laparoscopic and open incisional hernia repair - a prospective cohort study. Int J Surg 48:220–224. https://doi.org/10.1016/j.ijsu.2017.11.006CrossRefPubMed

26.

The PelvEx Collaborative (2020) The global cost of pelvic exenteration: in-hospital perioperative costs. Br J Surg 107:e470–e471. https://doi.org/10.1002/bjs.11924CrossRef

Title: Evaluating postoperative hernia incidence and risk factors following pelvic exenteration
Authors: Nicole Anais Milanko
Michael Eamon Kelly
Greg Turner
Joeseph Kong
Cori Behrenbruch
Helen Mohan
Glen Guerra
Satish Warrier
Jacob McCormick
Alexander Heriot
Publication date: 01-12-2024
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 1/2024
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-024-04638-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Evaluating postoperative hernia incidence and risk factors following pelvic exenteration

Abstract

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Systematic review and meta-analysis of the management of acute uncomplicated diverticulitis: time to change traditional practice

Long-term results and quality of life after stapled hemorrhoidopexy vs Doppler-guided HAL-RAR: a propensity score matching analysis

Short-term postoperative outcomes for obese versus non-obese inflammatory bowel disease patients undergoing bowel resection: a propensity score matched analysis

Evaluation of anorectal function using real-time tissue elastography before and after preoperative chemoradiotherapy

Predictors of recurrence and long-term patient reported outcomes following surgical repair of anal fistula, a retrospective analysis

Reliability and validity of the Turkish version of the New Cleveland Clinic Colorectal Cancer Quality of Life Questionnaire