Outcome of total pelvic exenteration for locally recurrent rectal cancer.
OBJECTIVE
Local recurrence occurs in 10 to 30% of patients with rectal cancer following curative resection. However treatment of choice remains controversial. We assessed the results of total pelvic exenteration for locally recurrent cancer of the rectum retrospectively.


METHODS
We reviewed medical charts of 45 patients with rectal cancer who underwent curative total pelvic exenteration for local recurrence. The cause of recurrence was classified into four groups: anastomotic, surgical cut-end, implantation, and lymphatic based on pathologic findings and computed tomography. Long-term survival was correlated with clinicopathologic variables.


RESULTS
Postoperative morbidity was 77.8% and in-hospital death occurred in 13.3% of patients. The overall 5-year survival rate was 14.1%. The 5-year survival rates stratified according to the expectation of curability were 31.6% for absolutely curative resection, 7.8% for relatively curative resection, and 0% for non-curative resection. Multivariate analysis revealed that the disease-free interval was the only independent prognostic factor. There was no benefit from perioperative radiation or intraoperative continuous pelvic peritoneal perfusion of the pelvis.


CONCLUSIONS
Total pelvic exenteration for local recurrence of rectal cancer can achieve long-term survival when curative resection is possible and the disease-free interval is long.
Ike
Hideyuki
H
Second Department of Surgery, Yokohama City University, Yokohama, Japan. ikeycu2s@urahp.yokohama-cu.ac.jp
Shimada
Hiroshi
H
Ohki
Shigeo
S
Yamaguchi
Shigeki
S
Ichikawa
Yasushi
Y
Fujii
Shouichi
S
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D010385:Pelvic Exenteration; D011183:Postoperative Complications / Q000401:mortality; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed