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Patterns of recurrence following pelvic exenteration and external radiotherapy for locally advanced primary rectal adenocarcinoma

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Abstract

Background: Local recurrence remains the main site of failure after pelvic exenteration for locally advanced primary rectal adenocarcinoma. This is a report on the patterns of recurrence in a group of such patients treated with pelvic exenteration and radiotherapy.

Methods: Between 1980 and 1992, we treated 49 patients. Thirty-one received preoperative radiotherapy (pre-RT), 4,500 cGy. Six weeks later, we performed posterior pelvic exenteration (PPE) in 21 patients, and total pelvic exenteration (TPE) in 10. Nine patients received postoperative radiotherapy (post-RT), 5,000 cGy after a PPE. Nine patients had surgery only, PPE (n=7) and TPE (n=2).

Results: Surgical mortality occurred in 16% of those patients who received pre-RT. The median follow-up was 52 months. Recurrences occurred in 23% of those patients who received pre-RT (local, one; local/distant, one; distant, four); in 88% of those patients treated with surgery only (local/distant, four; distant, four); and in 11% of those treated with post-RT (distant, one). The 5-year survival for patients who received radiotherapy was 66 versus 44% for those treated with surgery only.

Conclusion: Local control of locally advanced primary rectal adenocarcinoma requiring a pelvic exenteration is improved by the addition of radiotherapy. When recurrences do occur they are predominantly at extrapelvic sites.

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Authors and Affiliations

  1. Research Fellow Surgical Oncology, Hospital de Oncologia, Centro Medico Nacional Siglo XXI, IMSS, Mexico City, Mexico

    Nicolas Ortiz MD

  2. Division of Radiotherapy, Hospital de Oncologia, Centro Medico Nacional Siglo XXI, IMSS, Mexico City, Mexico

    Serafin Delgado MD

  3. Statistical Section, Hospital de Oncologia, Centro Medico Nacional Siglo XXI, IMSS, Mexico City, Mexico

    Sonia Labastida MD

  4. SUNY Health Science Center at Brooklyn, Brooklyn, New York, USA

    Lemuel Herrera MD

  5. Colorectal Service, Surgical Oncology Department, Hospital de Oncologia, Centro Medico Nacional Siglo XXI, IMSS, Puerto Mexico 53-101 Col. Roma Sur., CP 06760, Mexico D.F., Mexico

    Pedro Luna-Perez MD, Nicolas Ortiz MD & Dario Rodriguez MD

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  1. Pedro Luna-Perez MD
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  2. Serafin Delgado MD
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  3. Sonia Labastida MD
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  4. Nicolas Ortiz MD
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  5. Dario Rodriguez MD
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  6. Lemuel Herrera MD
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Luna-Perez, P., Delgado, S., Labastida, S. et al. Patterns of recurrence following pelvic exenteration and external radiotherapy for locally advanced primary rectal adenocarcinoma. Annals of Surgical Oncology 3, 526–533 (1996). https://doi.org/10.1007/BF02306084

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  • DOI: https://doi.org/10.1007/BF02306084

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