title: Bladder-sparing extended resection of locally advanced rectal cancer involving the prostate and seminal vesicles.
abstract: 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.
authors: Division of Colorectal and Pelvic Surgery, Department of Surgical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan.
authors: Norio
authors: N
authors: Saito
authors: Takanori
authors: T
authors: Suzuki
authors: Masanori
authors: M
authors: Sugito
authors: Masaaki
authors: M
authors: Ito
authors: Akihiro
authors: A
authors: Kobayashi
authors: Toshiyuki
authors: T
authors: Tanaka
authors: Masahito
authors: M
authors: Kotaka
authors: Hirokazu
authors: H
authors: Karaki
authors: Takaya
authors: T
authors: Kobatake
authors: Yoshiyuki
authors: Y
authors: Tsunoda
authors: Akio
authors: A
authors: Shiomi
authors: Masaaki
authors: M
authors: Yano
authors: Nozomi
authors: N
authors: Minagawa
authors: Yuji
authors: Y
authors: Nishizawa
mesh_terms: 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*