Early Postoperative Complications after Pelvic Exenteration

Abstract

Background. Radiation therapy is an integral part of the treatment of most malignant neoplasms of the pelvic organs, which in 25–30% of cases can cause the development of late radiation complications; in addition, 2–8% of patients have severe complications with an outcome in fistulas of various localization. Also, tumors of this localization are prone to local-regional recurrence, which can be combined with late radiation injuries. One of the most radical, and, often, the only method of treating this extremely severe and prognostically unfavorable pathology is to perform evisceration of the pelvic organs; however, its implementation against the background of radiation damage to normal tissues, leading to a significant decrease in the reparative potential, inevitably leads to a high risk of postoperative complications. Methods. A retrospective analysis of early postoperative complications on the Clavien–Dindo scale was carried out in 136 patients after pelvic evisceration performed at the A.F. Tsyba MRSC in 2019–2021. All patients in the perioperative period underwent complex conservative therapy, including nutritional support. Results. Pelvic evisceration was performed due to the progression of the underlying disease in 57% of cases, in 29% — due to the development of severe late radiation injuries with an outcome in the fistula, in 14% — due to a combination of local recurrence of the underlying disease with radiation complications). Complications of grade I on the Clavien–Dindo scale were noted in 50%; II — in 20.5%; III — in 3.6%; grade IV — in 3%. There were no cases of postoperative mortality. Conclusions. Conducting active preoperative preparation of patients aimed at correcting anemia, dysproteinemia, pain syndrome, etc.; as well as modifying surgical techniques and improving the management tactics of postoperative patients can minimize the risk of postoperative complications in patients after pelvic evisceration.