European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026
Total pelvic exenterations for rectal cancer: Urological reconstruction and complications.
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Salama Ahmed, Salama Mahmoud, Calpin Gavin, Ryan Fintan, Kaur Ishapreet, Connaughton Éibhleann, Lonergan Peter, McLoughlin Louise C, Kelly Michael E
Аннотация
INTRODUCTION: Urinary reconstruction is a core component of total pelvic exenteration (TPE), yet urological outcomes remain poorly characterised. This systematic review and meta-analysis aimed to determine the rates of urological complications after TPE for rectal cancer.
METHODS: A systematic search of PubMed, EMBASE, Scopus, and MEDLINE was conducted in March 2025. Studies reporting urological outcomes after TPE for rectal cancer were included. Pooled proportions were calculated using the Freeman-Tukey double arcsine transformation and DerSimonian-Laird random-effects modelling. Corresponding authors were not contacted for additional disaggregated data.
RESULTS: Nine studies reporting 913 patient observations were included (published 1999-2025), with possible cohort overlap among reports from one institution. The ileal conduit was the dominant form of urinary diversion (93.0%; 95% CI 85.5-98.0%; I2 = 91.5%). The pooled ureteroenteric anastomotic leak rate was 6.7% (95% CI 4.9-8.7%; I2 = 0.0%). The pooled ureteroenteric stricture rate was 6.2% (95% CI 3.2-9.9%; I2 = 62.1%); a sensitivity analysis using long-term denominators yielded 8.0% (95% CI 5.8-10.5%; I2 = 0.0%). Urological reintervention was required in 13.2% of patients (95% CI 10.3-16.4%; I2 = 0.0%). No study reported quality-of-life data using a validated instrument.
CONCLUSION: Urological complications after TPE for rectal cancer are common. Approximately one in eight patients require urological reintervention. These findings inform patient counselling and underscore the need for structured postoperative urological surveillance. Whether specialist urological participation reduces complication rates requires comparative evaluation.
METHODS: A systematic search of PubMed, EMBASE, Scopus, and MEDLINE was conducted in March 2025. Studies reporting urological outcomes after TPE for rectal cancer were included. Pooled proportions were calculated using the Freeman-Tukey double arcsine transformation and DerSimonian-Laird random-effects modelling. Corresponding authors were not contacted for additional disaggregated data.
RESULTS: Nine studies reporting 913 patient observations were included (published 1999-2025), with possible cohort overlap among reports from one institution. The ileal conduit was the dominant form of urinary diversion (93.0%; 95% CI 85.5-98.0%; I2 = 91.5%). The pooled ureteroenteric anastomotic leak rate was 6.7% (95% CI 4.9-8.7%; I2 = 0.0%). The pooled ureteroenteric stricture rate was 6.2% (95% CI 3.2-9.9%; I2 = 62.1%); a sensitivity analysis using long-term denominators yielded 8.0% (95% CI 5.8-10.5%; I2 = 0.0%). Urological reintervention was required in 13.2% of patients (95% CI 10.3-16.4%; I2 = 0.0%). No study reported quality-of-life data using a validated instrument.
CONCLUSION: Urological complications after TPE for rectal cancer are common. Approximately one in eight patients require urological reintervention. These findings inform patient counselling and underscore the need for structured postoperative urological surveillance. Whether specialist urological participation reduces complication rates requires comparative evaluation.