Intraoperative and perioperative rectal wall integrity disruptions after prostatectomy for prostate cancer in two clinical centers: a review of treatment methods, outcomes, follow-up, and oncologic outcomes

Objective: to analyze clinical data from patients with rectal wall injury after prostatectomy, evaluate long-term surgical and oncologic outcomes, and assess the effectiveness of treatment methods.

Material and Methods. A retrospective analysis of 34 patients with prostate cancer with rectal wall injury was conducted.

Results. Biochemical recurrence was diagnosed in 16 men (47.1 %) with a median of 19.4 months and a median PsA of 0.8 ng/ml. local recurrence was diagnosed in 3 patients (8.8 %) after 3.9 months, 36.0 months and 80.7 months with PsA values of 0.46 ng/ml, 1.275 ng/ml and 5.24 ng/ml, respectively. Generalization of prostate cancer was confirmed in 10 men (29.4 %) with a median of 50.3 months and a median PsA of 18.7 ng/ml. Hormonal resistance of prostate cancer developed in 4 patients (11.8 %). The median follow-up of patients was 85.1 months. One-year mortality was 2.9 %. three patients were lost to follow-up after 12 months, 1.5 years, and 4 years without progression of malignant neoplasms. ten deaths were confirmed from malignant neoplasms (n=6), circulatory diseases (n=3), and unlawful acts committed against the patient (n=1). at the time of follow-up, 21 patients (67.7 %) were alive, of whom 12 (57.1 %) showed no signs of prostate cancer progression.

Conclusion. in case of intraoperative and perioperative disruption of the integrity of the rectal wall after prostatectomy, restoration of the rectal defect or long-term carriage of urinary and/or intestinal stomas, possibly lifelong, does not affect the course of the tumor process and is not a direct cause of a reduction in life expectancy in men.

1. Axel E.M., Matveev V.B. Statistics of malignant tumors of urinary and male urogenital organs in Russia and the countries of the former USSR. Oncourology. 2019; 15(2): 15–24. (in Russian). doi: 10.17650/1726-9776-2019-15-2-15-24. EDN: VMMGKE.

2. Rawla P. Epidemiology of Prostate Cancer. World J Oncol. 2019; 10(2): 63–89. doi: 10.14740/wjon1191.

3. Kogan M.I., Laurent O.B., Petrov S.B. Radical prostate cancer surgery. Moscow. 2006, 352 p. (in Russian). ISBN: 5-9704-0188-9. EDN: QLMQRH.

4. Zenyukov A.S., Nadeshkin K.Yu., Pokorsky V.V., Yeremenko A. V., Shapoval A.A., Alyoshin V.M., Blashchuk I. M. Laparoscopic radical prostatectomy in the treatment of prostate cancer (on the example of the Regional Clinical Center of Oncology, Khabarovsk). Public Health of the Far East. 2020; 4: 48–51. (in Russian). doi: 10.33454/1728-1261-2020-3-48-51. EDN: JUZIHD.

5. Touijer K.A., Vertosick E.A., Sjoberg D.D., Liso N., Nalavenkata S., Melao B., Laudone V.P., Ehdaie B., Carver B., Eastham J.A., Scardino P.T., Vickers A.J. Pelvic Lymph Node Dissection in Prostate Cancer: Update from a Randomized Clinical Trial of Limited Versus Extended Dissection. Eur Urol. 2025; 87(2): 253–60. doi: 10.1016/j.eururo.2024.10.006.

6. Lestingi J.F.P., Guglielmetti G.B., Trinh Q.D., Coelho R.F., Pontes J. Jr., Bastos D.A., Cordeiro M.D., Sarkis A.S., Faraj S.F., Mitre A.I., Srougi M., Nahas W.C. Extended Versus Limited Pelvic Lymph Node Dissection During Radical Prostatectomy for Intermediateand Highrisk Prostate Cancer: Early Oncological Outcomes from a Randomized Phase 3 Trial. Eur Urol. 2021; 79(5): 595–604. doi: 10.1016/j. eururo.2020.11.040.

7. Zemlyanoy A.B., Magomedov Sh.S., Khanaliev B.V. Complications of robot-assisted prostatectomy. Bulletin of Pirogov National Medical & Surgical Center. 2020; 15(1): 120–25. (in Russian). doi: 10.25881/BPNMSC.2020.23.13.021. EDN: LOTZXM.

8. Chernyshev I.V., Abdullin I.I., Prosyannikov M.Yu., Gurbanov Sh.Sh., Keshishev N.G. Complications of extraperitoneoscopic radical prostatectomies. Oncourology. 2012; 3: 76–79. (in Russian). doi: 10.17650/17269776-2012-8-3-76-79. EDN: PTTFMT.

9. Buckley J.C. Complications after radical prostatectomy: anastomotic stricture and rectourethral fistula. Curr Opin Urol. 2011; 21(6): 461–564. doi: 10.1097/MOU.0b013e32834b7e1b.

10. Cornford P., van den Bergh R.C.N., Briers E., van den Broeck T., Brunckhorst O., Darraugh J., Eberli D., De Meerleer G., De Santis M., Farolfi A., Gandaglia G., Gillessen S., Grivas N., Henry A.M., Lardas M., van Leenders G.JL.H., Liew M., Linares Espinos E., Oldenburg J., van Oort I.M., Oprea-Lager D.E., Ploussard G., Roberts M.J., Rouvière O., Schoots I.G., Schouten N., Smith E.J., Stranne J., Wiegel T., Willemse P.M., Tilki D. EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer-2024 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2024; 86(2): 148–63. doi: 10.1016/j.eururo.2024.03.027.

11. Kim T.D., Thomas S., Kochar K., Park J.J., Marecik S. Transanal repair of a recto-urethral fistula after robotic prostatectomy. J Vis Surg. 2018; 4: 226. doi: 10.21037/jovs.2018.10.03.

12. Jeannot P., Faivre d’Arcier B., Bridoux V., Salamé E., Bruyère F., Ouaissi M. Long term outcome of multidisciplinary management of urethro-rectal fistula after urologic surgery. J Visc Surg. 2023; 160(2): 101–107. doi: 10.1016/j.jviscsurg.2022.07.003.

13. Belyaev A.M., Mikhnin A.E., Rogachev M.V. Data preparation and survival analysis in the packages of statistical programs MedCalc and Statistica. Textbook for students in the system of higher and additional professional education. St. Petersburg, 2022. 56 p. (in Russian). ISBN: 978-5-6046979-6-2.

14. Riffenburgh R.H., Gillen D.L. Statistics in Medicine. 4th Edition. Academic Press, 2020: 786 р. ISBN: 9780128153284.

15. Мамаев А.Н., Кудлай Д.А. Статистические методы в медицине. М., 2021. 136 с. [Mamaev A.N., Kudlay D.A. Statistical methods in medicine. Moscow, 2021. 136 p. (in Russian). ISBN: 978-5-98811-635-6. EDN: CAMDPS.

16. Navidi W., Monk B. Elementary Statistics. 4th Edition. McGraw Hill, 2021. 848 р. ISBN: 978-1260727876.

17. Erdik A., Cimen H.I., Gul D., Atik Y.T., Akca Y.M., Halis F., Kose O., Saglam H.S. Rectal Injury During Radical Prostatectomy: Incidence, Management, and Outcomes in Single-Center Experience. Cancers (Basel). 2025; 17(7): 1129. doi: 10.3390/cancers17071129.

18. Romito I., Giannarini G., Rossanese M., Mucciardi G., Simonato A., Ficarra V. Incidence of Rectal Injury After Radical Prostatectomy: A Systematic Review and Meta-analysis. Eur Urol Open Sci. 2023; 52: 85–99. doi: 10.1016/j.euros.2023.03.017.

19. Dudipala H., Dabbas M., Pandit K., Gurnani S.D., McKay R.R. Defining the Role of Postoperative Radio-Hormone Therapy in Prostate Cancer. Curr Oncol Rep. 2025; 27(8): 975–85. doi: 10.1007/s11912-025-01694-y.

20. Freedland S.J., Gao W., Lax A., Yang H., Ramaswamy K., Russell D., Hong A., Ivanova J.I. Real-world outcomes following biochemical recurrence after definitive therapy with a short prostate-specific antigen doubling time: potential role of early secondary treatment. Prostate Cancer Prostatic Dis. 2025; 28(3): 809–16. doi: 10.1038/s41391-024-00894-0.

21. Nyushko K.M., Perepukhov V.М., Gavrilova V.D., Alekseev B.Ya. Nomograms for predicting the risk of biochemical recurrence in patients with prostate cancer after surgery. Oncourology. 2021; 17(4): 100–110. (in Russian). doi: 10.17650/1726-9776-2021-17-4-100-110. EDN: VAKEWC.

22. Scharl S., Gartner L., Böhmer D.H.G., Siegmann A., Thamm R., Krafcsik M., Mayer B., Zips D., Ruf C., Wiegel T. Undetectable PSApredicts outcome after salvage radiotherapy for biochemical recurrence following radical prostatectomy. Radiother Oncol. 2024; 200: 110476. doi: 10.1016/j.radonc.2024.110476.

23. Pavlov A.Yu., Dzidzaria A.G., Tsibulskiy A.D., Mirzakhanov R.I., Khalil I.I. Evolution of salvage therapy for biochemical recurrence of prostate cancer after radical prostatectomy. Herald of the Russian Scientific Center of Roentgenoradiology. 2023; 23(2): 38–51. (in Russian). EDN: LNUHFW.

24. Falagario U.G., Abbadi A., Remmers S., Björnebo L., Bogdanovic D., Martini A., Valdman A., Carrieri G., Menon M., Akre O., Eklund M., Nordström T., Grönberg H., Lantz A., Wiklund P. Biochemical Recurrence and Risk of Mortality Following Radiotherapy or Radical Prostatectomy. JAMA Netw Open. 2023; 6(9): e2332900. doi: 10.1001/jamanetworkopen.2023.32900.

25. Sciarra A., Santarelli V., Salciccia S., Moriconi M., Basile G., Santodirocco L., Carino D., Frisenda M., Di Pierro G., Del Giudice F., Gentilucci A., Bevilacqua G. How the Management of Biochemical Recurrence in Prostate Cancer Will Be Modified by the Concept of Anticipation and Incrementation of Therapy. Cancers (Basel). 2024; 16(4): 764. doi: 10.3390/cancers16040764.

26. Stensland K.D., Caram M.E.V., Herr D.J., Burns J.A., Sparks J.B., Elliott D.A., Shin C., Morgan T.M., Zaslavsky A., Hollenbeck B.K., Tsodikov A., Skolarus T.A. National Long-term Survival Estimates After Radical Prostatectomy for Prostate Cancer. Urology. 2024; 184: 135–41. doi: 10.1016/j.urology.2023.10.018.

27. Veliev E.I., Sokolov E.A., Loran O.B. Improvement of recurrence-free survival after radical prostatectomy for locally advanced prostate cancer in relation to the time of surgical intervention. Oncourology. 2016; 12(1): 69–73. (in Russian). doi: 10.17650/1726-9776-2016-12-1-69-73. EDN: WALWLD.

28. Barbas Bernardos G., Herranz Amo F., González San Segundo C., Caño Velasco J., Subirá Ríos D., Moralejo Gárate M., Mayor de Castro J., Aragón Chamizo J., Hernández Fernández C. Survival analysis of patients with prostate cancer and unfavorable risk factors treated with radical prostatectomy and salvage radiotherapy after biochemical recurrence and persistence. Actas Urol Esp (Engl Ed). 2020; 44(10): 701–707. doi: 10.1016/j.acuro.2020.02.001.

29. Freedland S.J., Humphreys E.B., Mangold L.A., Eisenberger M., Dorey F.J., Walsh P.C., Partin A.W. Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA. 2005; 294(4): 433–39. doi: 10.1001/jama.294.4.433.