{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:28:38Z","timestamp":1787063318420,"version":"build-2736575974"},"reference-count":15,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T00:00:00Z","timestamp":1745712000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Total pelvic exenteration (TPE) has emerged as the standard treatment for advanced anorectal, genitourinary and soft\u2010tissue pelvic tumours. Long\u2010term complications, particularly empty pelvis syndrome (EPS) leading to enteroperineal fistula (EPF), remain inadequately addressed. The surgical management of EPF poses significant challenges, with limited published data and no official guidelines. This study aimed to investigate the incidence and outcomes of EPFs after TPE and to describe the management of reoperative surgery in this patient cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Patients who underwent TPE at Royal Prince Alfred Hospital, Sydney, Australia, between 2009 and 2024 were identified. Clinical data from a prospectively maintained database on reoperative surgery for EPFs were obtained. Patients were excluded if reoperative surgery was clearly unrelated to previous exenteration. Comparisons were then made between the two strategies used for surgical management of EPFs, namely small bowel resection with anastomosis and intestinal bypass with distal limbs exclusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 491 patients who underwent TPE, 22 (4.5%) developed an EPF requiring reoperative procedures. The 30\u2010day major complication rate was 18.2%. Postoperative complications were prevalent (95.2%) across both groups. The median time to EPF surgery post\u2010TPE was 21.7\u2009months. Notably, intensive care unit (ICU) admission was 2\u2009days shorter and length of stay was 14\u2009days shorter in the bypass group than in the small bowel resection with anastomosis group, although both differences were not statistically significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Strategies for preventing EPFs remain elusive; however, surgical management is feasible with acceptable short\u2010term outcomes. The optimal strategy should be tailored to individual patient characteristics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/codi.70085","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T01:35:12Z","timestamp":1745804112000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Management of enteroperineal fistulas following pelvic exenteration: Insights from a high\u2010volume referral centre"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9307-3142","authenticated-orcid":false,"given":"Darius Kang Lie","family":"Aw","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery, Royal Prince Alfred Hospital Sydney Local Health District  Sydney New South Wales Australia"},{"name":"Department of General Surgery Seng Kang General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0967-8515","authenticated-orcid":false,"given":"Kilian G. M.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Royal Prince Alfred Hospital Sydney Local Health District  Sydney New South Wales Australia"},{"name":"Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital Sydney Local Health District  Sydney New South Wales Australia"},{"name":"Institute of Academic Surgery at RPA  Sydney New South Wales Australia"},{"name":"University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"El\u2010Hayek","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital Sydney Local Health District  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mollie","family":"Cahill","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital Sydney Local Health District  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirk K. S.","family":"Austin","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Royal Prince Alfred Hospital Sydney Local Health District  Sydney New South Wales Australia"},{"name":"Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital Sydney Local Health District  Sydney New South Wales Australia"},{"name":"Institute of Academic Surgery at RPA  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter Jun Myung","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Royal Prince Alfred Hospital Sydney Local Health District  Sydney New South Wales Australia"},{"name":"Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital Sydney Local Health District  Sydney New South Wales Australia"},{"name":"Institute of Academic Surgery at RPA  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Byrne","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Royal Prince Alfred Hospital Sydney Local Health District  Sydney New South Wales Australia"},{"name":"Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital Sydney Local Health District  Sydney New South Wales Australia"},{"name":"Institute of Academic Surgery at RPA  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5602-6045","authenticated-orcid":false,"given":"Michael J.","family":"Solomon","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Royal Prince Alfred Hospital Sydney Local Health District  Sydney New South Wales Australia"},{"name":"Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital Sydney Local Health District  Sydney New South Wales Australia"},{"name":"Institute of Academic Surgery at RPA  Sydney New South Wales Australia"},{"name":"University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,27]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.11203"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs5.75"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-018-1883-1"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-019-07817-7"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.14523"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(194807)1:2<177::AID-CNCR2820010203>3.0.CO;2-A"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002\u20109378(62)90424\u20106"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.15956"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjs\/znae042"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0090\u20108258(76)90046\u20109"},{"issue":"5","key":"e_1_2_15_12_1","first-page":"630","article-title":"Intestinal fis\u2010 tula and obstruction following pelvic exenteration","volume":"152","author":"Lifshitz S","year":"1981","journal-title":"Surg Gynecol Obstet"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-006-9117-6"},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.21037\/jgo.2019.01.21"},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.16238"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.suronc.2022.101787"}],"container-title":["Colorectal 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