EP465 - Challenges and Lessons in Re-operative Pelvic Surgery.

Sunday, May 11, 2025

12:40 PM – 12:45 PM PT

Location: Monitor 10, Sails Pavilion, Upper Level

ePoster Presenter(s)

Selim Gebran, MD

Resident
Allegheny Health Network
Pittsburgh, PA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Richard Fortunato, DO (he/him/his)

Program Director, Colorectal Fellowship
Allegheny Health Network
Drexel University College Of Medicine
Pittsburgh, PA, United States

Disclosure information not submitted.
HT

Hao Tang, DO

Resident
Allegheny Health Network
Pittsburgh, Pennsylvania, United States

Disclosure information not submitted.
Kendall Post, MD (she/her/hers)

General Surgery Resident
Allegheny Health Network
Pittsburgh, PA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
SJ

Salvatore C. Jerris, DO

Resident
HCA Orange Park Hospital
Jacksonville, Florida, United States

Disclosure information not submitted.

Senior Author(s)

JM

James McCormick, DO, FACS, FASCRS

System Chief, Colon and Rectal Surgery
Allegheny Health Network
Pittsburgh, Pennsylvania, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Selim Gebran, MD: This individual has no financial relationships with ineligible companies.

Kendall Post, MD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Re-operative pelvic surgery is highly complex and there is a lack of data or society recommendations on management of the re-operative pelvis. We aimed to describe our experience with re-operative pelvic surgery.

Methods/Interventions: Patients who underwent re-operative proctectomy at a single tertiary-center between 2021 and 2023 were examined. Re-operative surgical indications, perioperative characteristics, intraoperative findings, ability to perform re-operative goals, permanent ostomy creation, and 30-day complications were evaluated. A qualitative analysis was then performed in order to formulate best practice recommendations for the management of re-operative pelvic surgery.

Results/Outcomes: A total of 43 patients who underwent re-operative pelvic surgery were included. The mean age was 63 years (SD 10), and 56% were males. The most common diagnosis was rectal cancer (n=24, 56%), followed by IBD (n=6, 14%). The median time from initial to re-operative pelvic surgery was 24 months (IQR 10-60). More than half of patients had received prior pelvic radiation (n=25, 58%) and 51% (n=22) received a sphincter preserving surgery at re-operation. Indications for reoperation were most commonly local cancer recurrence (n=14, 33%) and anastomotic fistula (n=12, 28%). Overall, 70% of re-operative procedures were performed minimally invasively (n=30, robot-assisted n=27), with 93% being completed without conversion to an open approach (n=28). Thirty-day complications occurred in 21% (n=9) and most commonly were perineal wound complications (n=4) or delayed urologic complications (n=3). In 70% of cases (n=30) our re-operative surgery accomplished its primary goal, most commonly improved quality of life (n=20/28) or R0 resection (n=10/15).

Conclusion/Discussion: Our study demonstrated that oncological curative resection and restoration of bowel continuity can be achieved in the majority of re-operative pelvic surgery using a minimally invasive approach. Although the complication rate was low, our experience has suggested that maintenance of double-J ureteral stents may reduce delayed urologic complications. Re-operative pelvic surgery requires complex preoperative planning and intraoperative decision-making, and future research should continue to determine best practice parameters in this high-risk surgical population.