Systematic review assessing complications related to the urinary tract reconstruction following total pelvic exenteration for locally advanced or recurrent pelvic cancer

Background Total pelvic exenteration (TPE) is an extensive procedure with a high complication rate, and often in conjunction with chemotherapy or radiotherapy or both, is the only chance of cure in patients with locally advanced or recurrent pelvic malignancy. There is a relative paucity of data reported related to complications from the urinary tract reconstruction. Objectives The aim of this report is to perform the first systematic review of complications relating to urinary tract reconstruction as part of TPE. Design Systematic Review in accordance with PRISMA guidelines. Data Sources and Methods A systematic review was conducted using Pubmed/Medline for English language published articles reporting urinary tract complications following TPE in studies reporting on at least 10 patients and between 1990-2023. Risk of bias assessment was conducted using ROBINS-I and Newcastle-Ottawa assessment tools. The quality of evidence was assessed using GRADE. Results In total, 2031 articles were screened with 19 included in the final review. Overall, 1566 patients underwent TPE. The age range of the cohort was 15-92. There were 779 urological complications (49.7 %), with some patients having multiple complications. The most common complications observed were UTI/pyelonephritis (n=216) uretero-enteric anastomotic leakages (n=125), hydronephrosis (n=83) and stricture (n=75). Of the 14 studies reporting results for specific urinary diversions, the use of continent diversion, as compared to incontinent diversion, was worse or comparable for all complications. The overall certainty of evidence is low due to imprecisions and inconsistency in the recording of results. Conclusion Urinary complication rates for TPE are high overall. Continent diversions were generally associated with higher rates of complications compared to incontinent. There is a clear need for reporting of urological complications in a consistent and standardised way in future TPE publications. Registration This review was registered on the PROSPERO website (CRD42021212093).