Perioperative outcomes in male patients undergoing cystectomy, radical colorectal procedure or total pelvic exenteration

Ushasi Naha; Artyom Khurshudyan; Hari T Vigneswaran; Mahmoud Mima; Michael R Abern; Daniel M Moreira

doi:10.21037/tau-23-266

Perioperative outcomes in male patients undergoing cystectomy, radical colorectal procedure or total pelvic exenteration

Transl Androl Urol. 2023 Nov 30;12(11):1631-1637. doi: 10.21037/tau-23-266. Epub 2023 Nov 23.

Authors

Ushasi Naha¹, Artyom Khurshudyan², Hari T Vigneswaran¹, Mahmoud Mima¹, Michael R Abern³, Daniel M Moreira¹

Affiliations

¹ Department of Urology, University of Illinois College of Medicine, Chicago, IL, USA.
² Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
³ Department of Urology, Duke University School of Medicine, Durham, NC, USA.

Abstract

Background: Total pelvic exenteration (TPE) in men is a surgical procedure to treat genitourinary and colorectal malignancies. Despite improvement in multimodal strategies and technology, mortality is still high and literature is limited about perioperative outcomes comparison to other radical procedures.

Methods: We analyzed National Surgical Quality Improvement Program (NSQIP) baseline database of all male patients undergoing cystectomy, low anterior resection/abdominoperineal resection (LAR/APR) or TPE from January 1, 2005 to December 31, 2016. Postoperative complications within 30 days after surgery were measured including: Wound infection, septic complications, deep vein thrombosis, cardiovascular events, and return to the operating room or mortality, etc. Differences between groups were analyzed using analysis of variance (ANOVA) tests.

Results: A total of 7,375 patients underwent radical cystectomy, 49,762 underwent LAR/APR and 792 underwent TPE. Cystectomy patients were on average older compared to TPE or LAR/APR patients (P<0.001). In univariable and multivariable analysis, patients undergoing TPE had greater infectious and septic complications compared to cystectomy (odds ratio =1.09; 95% confidence interval (CI): 1.06-1.12) and LAR/APR (odds ratio =1.08; 95% CI: 1.05-1.11). Moreover, TPE had a slightly higher mortality within the 30-day postoperatively than those who underwent LAR/APR (odds ratio =1.01; 95% CI: 1.00-1.02) and cystectomy (odds ratio =1.01; 95% CI: 1.00-1.01).

Conclusions: Men undergoing TPE had greater rates of infections and postoperative complications compared to those undergoing radical cystectomy and LAR/APR. From a clinical standpoint, TPE has high morbidity that could provide opportunity for quality improvement projects with the goal of mitigating high complication rates.

Keywords: Total pelvic exenteration (TPE); abdominoperineal resection (APR); cystectomy; low anterior resection (LAR); perioperative outcomes.