Introduction: In patients with locally advanced (LARC) or recurrent (LRRC) rectal cancer and bladder involvement, pelvic exenteration (PE) with partial (PC) or radical (RC) cystectomy can potentially be curative. Urinary tract reconstruction involves ileal/colonic conduit for RC, or either primary bladder repair or ureteric reimplantation with Boari flap and psoas hitch for PC. Where PC potentially provides less post-operative morbidity, a radical resection is the most important prognostic factor for survival. The purpose of this study was to compare PC and RC in PE patients in terms of oncological outcome and post-operative complications. Methods: This was a retrospective cohort analysis of a prospectively maintained surgical database. Patients who underwent PE for LARC or LRRC with bladder involvement between 1998 and 2021 were included. Post-operative complications and overall survival were compared between patients with PC and RC. Statistical analysis was performed using SPSS. Results: 329 patients were included; 60 patients with PC and 269 with RC. No significant difference in R0 resection was observed between PC and RC groups (81.8% versus 84.7%, P=0.621). 10 patients in PC group had a positive margin; in 3/10 patients this was at the bladder or ureter margin. Patients with LRRC and PC had poorest oncological outcome with 69% R0 resection; patients with LARC and PC demonstrated highest R0 rate of 96.3% (P=0.008). Overall survival (OS) was 88 months versus 58 months in the PC and RC group, respectively (P=0.265). 1-, 3- and 5-year OS were 90.8%, 68.1% and 58.6% in PC group, and 88.7%, 62.2% and 49.5% in the RC group. Factors that were significantly associated with poorer OS included age, positive resection margin and longer duration of surgery. RC patients demonstrated longer operating time, higher intra-operative blood loss, and longer hospital stay. RC patients also experienced significantly higher rates of wound related complications (25.0% vs. 39.8%, P=0.032). Rates of urinary sepsis or urological leaks did not differ between groups. Conclusions: This study demonstrates that PC as part of a PE can be performed safely without compromising oncological outcome in patients with LARC. In patients with LRRC, PC results in poor oncological outcome and a more aggressive surgical approach with RC seems justified. The main benefit of PC is a reduction in wound related complications compared to RC, although more urological re-interventions are observed in this group. SOURCE OF Funding: No funding sources to declare.
