Options for Surgical Reconstruction of the Heavily Irradiated Pelvis

Pelvic cancers in which radiation therapy is frequently employed include gastrointestinal (i.e., colorectal, anal), genitourinary (i.e., bladder, urethral), gynecologic (i.e., cervical, endometrial, vaginal, and vulvar), and orthopedic cancers. Pelvic radiation can induce tissue toxicity and damage in the bowel, bladder, genitalia, and along the upper and lower urinary tracts. Factors associated with radiation-induced GU toxicity include the cumulative radiation dose, radiation modality, treatment volume, and prior pelvic surgery. Pelvic radiation is implicated in the development of several genitourinary complications which can have a devastating impact on patient QoL, bladder and sexual function, and even survival as recurrent infections, deterioration in renal function, and life-threatening hemorrhage contribute to increased morbidity and mortality. Prior to operation, preoperative consultation with a plastic and reconstructive surgeon is critical to establish a physiologic baseline and discuss postoperative expectations. Open discussion regarding postoperative functional and aesthetic changes, prior to surgery, dramatically reduces anxiety for the patient and sets realistic goals for both patient and surgeon. Numerous options for reconstruction are available depending on the severity and nature of the urinary tract and pelvic floor complications. Multidisciplinary co-management is often required, and a collaborative approach to surgical reconstruction allows for efficiency in care, improving outcomes, and minimizing patient morbidity and mortality.