Ileal orthotopic neobladder after pelvic exenteration for cervical cancer
Chiva LM (1), Lapuente F, Núñez C, Ramírez PT. (1) Department of Gynecologic Oncology, M. D. Anderson International España, Madrid, Spain
We aimed to describe our preliminary experience in creating an ileal orthotopic urinary conduit in patients with a history of pelvic irradiation undergoing pelvic exenteration for recurrent cervical cancer and to evaluate the feasibility, complication rates, and outcomes of this procedure.
A retrospective chart review was performed in all 6 patients who underwent ileal orthotopic neobladder creation at our institution between January 2005 and March 2008. Main outcome measures were surgical complications, continence rate, neobladder function, and oncologic outcome.
The mean patient age was 46.6 years (range, 38-61). Four patients underwent anterior exenteration and 2 total pelvic exenterations. There were no intraoperative complications. The median operative time was 456 min (range, 372-600). The median time to create the orthotopic urinary conduit was 70 min (range, 55-90). Three patients had postoperative neobladder anastomotic leak.
Two of them had this complication successfully managed conservatively and 1 surgically. Daytime urinary continence was good or satisfactory in 4 of 6 patients. Nighttime urinary continence was good or satisfactory in 3 of 6 patients. All patients reported being satisfied with their decision to undergo this procedure. Median follow-up time was 20.5 months (range, 6-34). At last visit, 3 patients were alive without evidence of disease, 1 was alive with stable retroperitoneal disease, and 2 had died of disease recurrence after exenteration.
Ileal orthotopic neobladder creation in patients undergoing exenteration for recurrent cervical cancer is feasible after radiation. The rate of urinary continence is acceptable.
CITATION Gynecol Oncol. 2009 Apr;113(1):47-51. doi: 10.1016/j.ygyno.2008.12.020. Epub 2009 Jan 26.