Urologic Complications of Composite Resection Following Combined Modality Treatment of Colorectal Cancer

Background: It is a common perception that preoperative radiation increases the incidence of urologic complications following composite resection, but there is little evidence to support or refute this claim.

Methods: Patients who underwent ureteric reconstruction as a component of en bloc resection for locally advanced or recurrent colorectal cancer were identified from a multicenter institutional database (1982-2007). Charts were reviewed to determine the incidence, nature, management, and predictors of serious urologic complications.

Results: 126 patients (34 female, 92 male) met the inclusion criteria: (1) division of one or both ureters; and (2) ureteric reconstruction involving anastomosis to ureter, bladder, small bowel or colon. Urologic complications requiring intervention occurred in 30 (24%) patients, including: anastomotic leak (n = 11), anastomotic stricture (n = 10), fistula (n = 5), conduit/stoma problem (n = 5), and other (n = 3). Eight patients required surgical revision. The rate of urologic complications was similar in patients who had received radiation at some time prior to the index surgery and those who had not (25% and 19%, respectively, P = 0.61). There was a trend towards a higher complication rate with more complex compared with simpler reconstructive procedures (38% versus 20%, P = 0.069).

Conclusion: 24% of patients who underwent ureteric reconstruction following composite resection developed a urologic complication that required intervention. Preoperative radiotherapy did not appear to predispose patients to urologic complications. Optimization of surgical technique at the time of en bloc resection may obviate the need for subsequent revision.