Bladder-sparing extended resection of locally advanced rectal cancer involving the prostate and seminal vesicles.
OBJECTIVE
Total pelvic exenteration (TPE) is the standard procedure for locally advanced rectal cancer involving the prostate and seminal vesicles. We evaluated the feasibility of bladder-sparing surgery as an alternative to TPE.


METHODS
Eleven patients with advanced primary or recurrent rectal cancer involving the prostate or seminal vesicles, or both, underwent bladder-sparing extended colorectal resection with radical prostatectomy. The procedures performed were abdominoperineal resection (APR) with prostatectomy (n = 6), colorectal resection using intersphincteric resection combined with prostatectomy (n = 4), and abdominoperineal tumor resection with prostatectomy (n = 1). Local control and urinary and anal function were evaluated postoperatively.


RESULTS
Cysto-urethral anastomosis (CUA) was performed in seven patients and catheter-cystostomy was performed in four patients. Coloanal or colo-anal canal anastomosis was also performed in four patients. There was no mortality, and the morbidity rate was 38%. All patients underwent complete resection with negative surgical margins. After a median follow-up period of 26 months there was no sign of local recurrence, and ten patients were alive without disease, although distant metastases were found in three patients. Five patients had satisfactory voiding function after CUA, and three had satisfactory evacuation after intersphincteric resection (ISR).


CONCLUSIONS
These bladder-sparing procedures allow conservative surgery to be performed in selected patients with advanced rectal cancer involving the prostate or seminal vesicles, without compromising local control.
Saito
Norio
N
Division of Colorectal and Pelvic Surgery, Department of Surgical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan.
Suzuki
Takanori
T
Sugito
Masanori
M
Ito
Masaaki
M
Kobayashi
Akihiro
A
Tanaka
Toshiyuki
T
Kotaka
Masahito
M
Karaki
Hirokazu
H
Kobatake
Takaya
T
Tsunoda
Yoshiyuki
Y
Shiomi
Akio
A
Yano
Masaaki
M
Minagawa
Nozomi
N
Nishizawa
Yuji
Y
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000601:surgery*; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery*; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012669:Seminal Vesicles / Q000601:surgery*