Pelvic exenteration for advanced colorectal cancer with reconstruction of urinary and sphincter functions.
BACKGROUND
Total pelvic exenteration (TPE) for the treatment of advanced colorectal cancer usually involves a double stoma for faecal and urinary excretion, which reduces patient quality of life. In this study, a stomaless reconstruction method for patients normally requiring TPE was evaluated.


METHODS
Five patients underwent stomaless TPE. After removal of the tumour with an adequate surgical margin, the urethra was transected at the urogenital diaphragm and the rectum at the anal canal. An ileal neobladder was constructed and coloanal anastomosis was performed. The major omentum was used to construct a septum between the anastomoses. A transgastric ileus tube was used as an intestinal stent to prevent ileus.


RESULTS
All patients were alive 12-39 months after operation. Faecal continence was preserved in four patients whose diverting colostomies were closed. All five patients were able to void urine spontaneously, with daytime continence. All but one, in whom cancer recurred, were mobile in the community.


CONCLUSIONS
Stomaless TPE may be considered for locally advanced colorectal cancers that invade the genitourinary organs, provided that neither the anal canal nor the urogenital diaphragm is affected.
Koda
K
K
Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba City 260-8670, Japan. k-koda@umin.ac.jp
Tobe
T
T
Takiguchi
N
N
Oda
K
K
Ito
H
H
Miyazaki
M
M
D000368:Aged; D039021:Colonic Pouches; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010385:Pelvic Exenteration / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D012811:Sigmoid Neoplasms / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014547:Urinary Diversion / Q000379:methods