Pelvic exenteration (PE) including the radical en-block resection of at least two adjacent pelvic organs, regional lymph nodes and pelvic side wall is a major uro-oncological undertaking with frequent morbidity. This study aims to assess the rate of new chronic renal impairment, predictive factors, and association with urological intervention after PE at an Australian quaternary centre.

Patients who underwent PE with a genitourinary component at a single quaternary referral centre between January 2003 and July 2021 were included in this analysis. Data were collected prospectively over this time and analysed retrospectively. Complications were defined as early (< 30 days) or late (≥ 30 days), and were classified according to the Clavien-Dindo classification. Multivariable binary logistic regression was performed to determine predictors of chronic renal impairment (defined as any new renal impairment from baseline persisting 3 or more months, or an increase in CKD stage from baseline).

Overall, 424 patients underwent PE, of whom 213 (50.2%) had a genitourinary component. Median post-operative length of stay was 21.5 (IQR 15.3-32) days. Early post-operative (30-day) mortality was 0.5% and overall mortality at a median follow-up of 22.7 months was 40.4%. An early urological complication occurred in 106 (49.8%) patients, a late urological complication eventuated in 56 (26.3%) patients. Chronic kidney disease developed post-operatively in 39 (18.3%) patients at the completion of patient follow-up, with three patients requiring nephrectomy for loss of function of a single renal unit. Female sex and primary (as opposed to recurrent) malignancy were the only statistically significant predictors of new chronic renal impairment (OR [95% CI] 2.86 (1.33-6.16) and 2.18 (1.09-4.34), respectively).

Our experience with PE over a long follow-up period demonstrates urological complication rates consistent with the literature associated with urinary diversion and anastomosis. There were no modifiable risk factors for new chronic renal impairment after PE identified on multivariable regression analysis. Further research is required to delineate and mitigate risk factors for chronic renal impairment after PE.