542 Background: Patients with advanced primary or recurrent colorectal cancers that undergo total pelvic exenteration for cure or palliation require proximal urinary and fecal diversion. The most commonly used diversion technique is use of an ileal conduit (IC) and end colostomy. At our institute, the double-barreled wet colostomy (DBWC) has been shown to be have similar outcomes and technically feasible. Methods: Between 2004 and 2010, 37 patients underwent total pelvic exenteration for advanced primary or recurrent colorectal cancer. Two groups were identified based on the technique used for their urinary diversion, either by way of an IC (n = 4) or DBWC (n = 33). Demographics, periprocedural events, and outcomes were compared between the two groups. Results: The two groups were similar in the terms of age, gender, and comorbidities. Thirty-three patients (89%) underwent a DBWC and four patients (11%) underwent an IC. All of these patients underwent a total pelvic exenteration for advanced primary (27%) or recurrent colorectal cancer (73%) either for cure or for palliation. Twenty patients underwent R0 resection (54%), and 17 patients had non-R0 resection (46%). Complications, length of stay, and operative times between both groups were similar. Median survival for both groups showed no statistical difference. Conclusions: DBWC is a safe and feasible alternative to the traditional ileal conduit for urinary diversion. It provides a single stoma to care for, and an intact contralateral abdominal muscle to use as a vertical rectus abdominus musculocutaneous flap for reconstruction. This technique is easy to learn and is not associated with higher operative times, length of stay, morbidity, or mortality. [Table: see text] No significant financial relationships to disclose.
Simultaneous laparoscopic nephroureterectomy and robot-assisted anterior pelvic exenteration with intracorporeal ileal conduit urinary diversion: step-by-step video-illustrated technique
