title: Role of pelvic exenteration in the management of locally advanced primary and recurrent rectal cancer.
abstract: OBJECTIVE
  A review of a single-centre experience of pelvic exenteration as a treatment modality for patients with locally advanced primary and recurrent rectal cancer. The perioperative outcomes, morbidity and long term oncological outcomes are reviewed.
  
  
  METHODS
  Patients undergoing pelvic exenterations for recurrent and locally advanced rectal cancer between 1 January 2006 and 1 August 2012 were identified from a prospective database. All patients underwent pre-operative staging investigations with computed tomography (CT) scan of chest, abdomen and pelvis and pelvic magnetic resonance imaging (MRI). Patients with locally advanced primary rectal cancer were counselled for pre-operative chemoradiation. Structures such as the urinary bladder and female reproductive organs were resected en bloc where indicated with the lesion. Urological or plastic reconstructions were employed where indicated. The primary outcome measured was overall survival and secondary outcomes measured were time to local recurrence (LR) and systemic recurrence. Disease-free survival was examined by the Kaplan-Meier Method (Fig. 1).
  
  
  RESULTS
  Pelvic exenterations were performed in 13 patients with a median age of 59 (range 26-81). The rate of major post-operative complications was 8% (n = 1), where the patient had anastomotic leakage. There were no mortalities in the perioperative period. All patients were operated with curative intent and negative circumferential margins were shown in 9 out of 13 patients (70%). The DFS was 19.4 and the OS was 22.5 months.
  
  
  CONCLUSIONS
  An aggressive approach with en bloc resection of organs involved provides survival benefit to patients with locally advanced primary and recurrent rectal cancer with an acceptable morbidity profile.
authors.affiliation: Department of Surgical Oncology, National Cancer Centre Singapore, 9 Hospital Drive, Singapore, 169612, Singapore.
authors.forename: Koh Ye
authors.initials: KY
authors.lastname: Xin
authors.forename: Deanna Wan Jie
authors.initials: DW
authors.lastname: Ng
authors.forename: Grace Hwei Ching
authors.initials: GH
authors.lastname: Tan
authors.forename: Melissa Ching Ching
authors.initials: MC
authors.lastname: Teo
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000453:epidemiology; D016063:Blood Loss, Surgical; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D061646:Operative Time; D010385:Pelvic Exenteration / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome