Ileal orthotopic neobladder after pelvic exenteration for cervical cancer

OBJECTIVE:
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.

METHODS:
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.

RESULTS:
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.

CONCLUSIONS:
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.