Reconstruction of female oncologic peripelvic defects is challenging due to complex anatomy, neoadjuvant chemoradiation, resection margins, and subsequent wound healing risks. Functional restoration requires thoughtful perioperative management focused on both defect reconstruction and patient reported outcomes.

Methods

•Retrospective review of peripelvic defect reconstruction in female patients at MD Anderson Cancer Center from 2016 to 2023

•Data collected: Comorbidities, Tumor characteristics, Reconstructive details

•Complications: Non-operative within 30 days, Operative within 30 days

•Patient outcomes: Survival, Hernia rates, Sexual activity, Need for revision

Results (N=164)

•Indication for resection: Colorectal (57%), Anal (17%), Gynecologic (10%), Sarcoma (8%), Genitourinary (4%), Stricture or Fistula (4%)

•Resection Procedures: Open Resection+Vaginectomy (66%), Vaginectomy/Vulvectomy (10%), Robotic Resection+Vaginectomy (9%), Open Resection without Vaginectomy (7%), Fistula/Stricture Reconstruction (6%) Robotic Resection without Vaginectomy (2%)

•Reconstruction Procedures: Pedicled Flap (93%), Local Tissue Rearrangement (3%), Both (4%)

•Abdominal Wall Reconstruction: Overall (N=84, 51%): (82/84) 98% performed in Open Resections; Of All Patients with Open Resections (N=120): 68% Formal AWR, 60% Mesh, 36% Component Separation

•Complications: Overall (47%), Major (9%), Minor (38%), Hernia (5%)

Conclusions

Peripelvic soft tissue reconstruction in the oncologic population is safe, even in comorbid patients with neoadjuvant therapy. Thigh-based reconstruction is more common in robotic resections requiring vaginal reconstruction. Return to sexual activity is higher when given dilator therapy instruction.