Abstract
PURPOSE: The only possibility of a surgical cure in patients with locally advanced primary or recurrent rectal cancer would be an extended resection such as pelvic exenteration and sacral resection. The aim of this study was to evaluate the safety, tolerability, and survival benefits of these procedures. METHODS: Between 1988 and 1999, 64 patients with locally advanced primary or recurrent rectal cancer underwent abdominoperineal resection, with sacral resection in 9 patients, anterior pelvic exenteration in 8 patients, total pelvic exenteration in 27 patients, and total pelvic exenteration with sacral resection in 20 patients. RESULTS: Rates of morbidity, reoperation, and mortality were 50, 4.5, and 0 percent in 22 patients with primary cancer, and 60, 2.4, and 2.4 percent in 42 patients with recurrent disease, respectively. Major complications, such as sepsis, intra-abdominal abscess, and enteric fistula caused one hospital death and reoperation in two patients. In 21 patients who underwent curative resection for primary cancer, the overall five-year survival rates were 74.1 percent for Dukes B and 47.4 percent for Dukes C, although the difference was not statistically significant. Thirty patients with recurrent cancer who underwent curative resection had significantly improved survival, with a five-year survival rate of 22.9 percent, compared with 12 patients who underwent palliative resection, resulting in a survival rate of 0 percent (P = 0.0065). CONCLUSIONS: Pelvic exenteration and sacral resection for primary or recurrent rectal cancer are tolerable procedures with a low mortality rate. Although they provide a survival benefit if curative resection is possible, the associated morbidity remains high and should be followed up closely.
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References
RS Yeung FL Moffat RE Falk (1993) ArticleTitlePelvic exenteration for recurrent and extensive primary colorectal adenocarcinoma Cancer 72 1853–1868
WL Law KW Chu HK Choi (2000) ArticleTitleTotal pelvic exenteration for locally advanced rectal cancer J Am Coll Surg 190 78–83
HJ Wanebo RJ Koness MP Vezeridis SI Cohen DE Wrobleski (1994) ArticleTitlePelvic resection of recurrent rectal cancer Ann Surg 220 586–597
HJ Wanebo P Antoniuk RJ Koness et al. (1999) ArticleTitlePelvic resection of recurrent rectal cancer Dis Colon Rectum 42 1438–1448
S Maetani T Nishikawa Y Iijima et al. (1992) ArticleTitleExtensive en bloc resection of regionally recurrent carcinoma of the rectum Cancer 69 2876–2883
WJ Temple AS Ketcham (1992) ArticleTitleSacral resection for control of pelvic tumors Am J Surg 163 370–374
S Magrini H Nelson LL Gunderson FH Sim (1996) ArticleTitleSacropelvic resection and intraoperative electron irradiation in the management of recurrent anorectal cancer Dis Colon Rectum 39 1–9
J Zacherl R Schiessel R Windhager et al. (1999) ArticleTitleAbdominosacral resection of recurrent rectal cancer in the sacrum Dis Colon Rectum 42 1035–1040
MJ Lopez WW Monafo (1993) ArticleTitleRole of extended resection in the initial treatment of locally advanced colorectal carcinoma Surgery 113 365–372
J Hida M Yasutomi T Maruyama et al. (1998) ArticleTitleResults from pelvic exenteration for locally advanced colorectal cancer with lymph node metastases Dis Colon Rectum 41 165–168
JL McCall MR Cox DA Wattchow (1995) ArticleTitleAnalysis of local recurrence rates after surgery alone for rectal cancer Int J Colorectal Dis 10 126–132
KA Avradopoulos MP Vezeridis HJ Wanebo (1996) ArticleTitlePelvic exenteration for recurrent rectal cancer Adv Surg 29 215–233
CS Wong BJ Cummings JD Brierley et al. (1998) ArticleTitleTreatment of locally recurrent rectal carcinoma—results and prognostic factors Int Radiat Oncol Biol Phys 40 427–435
A Brunschwig (1948) ArticleTitleComplete excision of pelvic viscera for advanced carcinoma Cancer 1 177–183
HJ Wanebo DL Gaker E Whitehill RF Morgan WC Constable (1987) ArticleTitlePelvic recurrence of rectal cancer Ann Surg 205 482–495
GH Hafner L Herrera NJ Petrelli (1992) ArticleTitleMorbidity and mortality after pelvic exenteration for colorectal adenocarcinoma Ann Surg 215 63–67
MJ Lopez SB Standiford JL Skibba (1994) ArticleTitleTotal pelvic exenteration Arch Surg 129 390–395
P Luna-Perez DF Rodriguez D Flores S Delgado S Labastida (1995) ArticleTitleMorbidity and mortality following preoperative radiation therapy and total pelvic exenteration for primary rectal adenocarcinoma Surg Oncol 4 295–301
SR Bramhall JD Harrison A Burton et al. (1999) ArticleTitlePhase 2 trial of radical surgery for locally advanced pelvic neoplasia Br J Surg 86 805–812
P Russo B Ravindran J Katz P Paty J Guillem AM Cohen (1999) ArticleTitleUrinary diversion after total pelvic exenteration for rectal cancer Ann Surg Oncol 6 732–738
TW Burke M Morris MS Roh C Levenback DM Gerschenson (1995) ArticleTitlePerineal reconstruction using single gracilis myocutaneous flaps Gynecol Oncol 57 221–225
J de Ranieri J Souloy (1999) ArticleTitlePelvic filling and perineal reconstruction using longissimus dorsalis myocutaneous flap after total pelvic exenteration Chirurgie 124 45–50
GH Hafner L Herrera NJ Petrelli (1991) ArticleTitlePatterns of recurrence after pelvic exenteration for colorectal adenocarcinoma Arch Surg 126 1510–1513
C Rodel GG Grabenbauer KE Matzel et al. (2000) ArticleTitleExtensive surgery after high-dose preoperative chemoradiotherapy for locally advanced recurrent rectal cancer Dis Colon Rectum 43 312–319
PF Brophy JP Hoffman BL Eisenberg (1994) ArticleTitleThe role of palliative pelvic exenteration Am J Surg 167 386–390
K Yamada T Ishizawa K Niwa Y Chuman S Akiba T Aikou (2001) ArticleTitlePatterns of pelvic invasion are prognostic in the treatment of locally recurrent rectal cancer Br J Surg 88 988–993
GL Zheng B Eddleston PF Schofield RJ Johnson RD James (1984) ArticleTitleComputed tomographic scanning in rectal carcinoma J R Soc Med 77 915–923
R Farouk H Nelson E Radice S Mercill L Gunderson (1998) ArticleTitleAccuracy of computed tomography in determining respectability for locally advanced primary or recurrent colorectal cancers Am J Surg 175 283–287
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Yamada, K., Ishizawa, T., Niwa, K. et al. Pelvic Exenteration and Sacral Resection for Locally Advanced Primary and Recurrent Rectal Cancer. Dis Colon Rectum 45, 1078–1084 (2002). https://doi.org/10.1007/s10350-004-6363-1
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DOI: https://doi.org/10.1007/s10350-004-6363-1