MANAGEMENT OF PELVIC SEPSIS AFTER TOTAL MESORECTAL EXCISION FOR RECTAL CANCER - A 10-YEAR EXPERIENCE OF A NATIONAL REFERRAL CENTER
Sarah Sharabiany*1, Hanneke Joosten1, Gijsbert D. Musters1, Kevin Talboom1, Pieter Tanis2, Willem A. Bemelman1, Roel Hompes1
1Surgery, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, Netherlands; 2Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
Importance: Pelvic sepsis following rectal cancer surgery may lead to further dramatic consequences with significant impact on patients' quality of life. Centers generally manage their own complications despite restricted experience with these highly challenging cases and scarcely available literature on optimal approach.
Objective: To report outcomes for the management of pelvic sepsis after total mesorectal excision for rectal cancer over a 10-year period in a national referral center.
Design: Prospective observational study.
Setting: National referral center.
Participants: Referred patients with (chronic) pelvic sepsis after low anterior resection or Hartmann's procedure for rectal cancer.
Exposures: Based on year of referral, patients were divided into two groups: 2010-2014 (A) and 2015-2020 (B).
Main Outcomes and Measures: The main outcome was successful control of pelvic sepsis, with restoration of bowel continuity as co-primary outcome.
Results: In total 140 patients were included: 52 in group A and 88 in group B. Salvage management entailed a restorative procedure in 46% (65/140), a non-restorative procedure in 46% (64/140) and non-operative approach in 8% (11/140). In group A and B, the operative approach consisted of endoscopic vacuum assisted surgical closure in 15% (7/48) and 3% (2/81) (P=0.013), redo-anastomosis in 44% (21/48) and 43% (35/81) (P=1.000), and intersphincteric resection of the anastomosis in 42% (20/48) and 54% (44/81) (P=0.203), respectively. After a median follow-up of 83 months (IQR 39-100) in group A and 41 months (IQR 22-60) in group B, successful control of pelvic sepsis was achieved in all patients who received endoscopic vacuum assisted surgical closure, in 91% (19/21) and 89% (31/35) of patients who received redo-anastomosis (P=1.000), and 100% (20/20) and 93% (41/44) of patients who received intersphincteric resection of the anastomosis (P=0.546), respectively. Restorative procedures resulted in a functional anastomosis in 61% (17/28) of patients in group A and 68% (25/37) of patients in group B (P=0.567).
Conclusion and Relevance: High rates of success can be achieved with surgical salvage of pelvic sepsis in a dedicated tertiary referral center, without significant differences over time. In well selected and motivated patients a functional anastomosis can be achieved.
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