title: Excision of the seminal vesicles for locally advanced and recurrent rectal and sigmoid cancer.
abstract: BACKGROUND
  This study aims to define the clinical and oncological outcome of 'en-bloc' excision of the seminal vesicles for locally advanced and recurrent tumours of the sigmoid and rectum.
  
  
  METHODS
  Eight patients were identified from a prospective colorectal cancer database at a tertiary centre as having undergone excision of the seminal vesicles in continuity with a locally advanced or recurrent sigmoid or rectal adenocarcinoma. The presentation, operative details, histopathology, oncological outcome and morbidity of the procedure were assessed.
  
  
  RESULTS
  Three patients were referred with recurrent tumours related to an anastomosis and five had a locally advanced sigmoid or rectal cancer. The need for resection of the seminal vesicles was determined from the preoperative pelvic magnetic resonance imaging scan or from an intraoperative finding of loss of the plane of dissection anterior to Denonvilliers' fascia. Restorative resection was achieved in all three patients where the primary tumour was located in the sigmoid or rectosigmoid, while all five patients with a rectal tumour had a permanent stoma. After a median follow-up of 43 months, seven patients are alive and disease-free and one patient has died of distant metastases. No patient has suffered a local recurrence. All five patients who were sexually active before surgery suffered from post-operative impotence. Two patients had temporary urinary retention with overflow.
  
  
  CONCLUSIONS
  In carefully selected patients with locally advanced or recurrent rectal and sigmoid cancers that are attached to the seminal vesicles, en-bloc excision confers excellent local control but is associated with a high rate of sexual morbidity.
authors.affiliation: Department of General Surgery, Wellington Hospital, Wellington, New Zealand.
authors.forename: John P
authors.initials: JP
authors.lastname: Keating
authors.affiliation: Department of General Surgery, Wellington Hospital, Wellington, New Zealand.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Manning
authors.affiliation: Department of Surgery and Anaesthesia, Wellington School of Medicine and Health Sciences, Wellington, New Zealand.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dennett
authors.affiliation: Department of Urology, Wellington Hospital, Wellington, New Zealand.
authors.forename: Rod
authors.initials: R
authors.lastname: Studd
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D012809:Colon, Sigmoid / Q000473:pathology* / Q000601:surgery; D007172:Erectile Dysfunction / Q000150:complications; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010385:Pelvic Exenteration / Q000009:adverse effects* / Q000379:methods; D010388:Pelvis / Q000000981:diagnostic imaging; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000473:pathology* / Q000601:surgery; D012008:Recurrence; D012669:Seminal Vesicles / Q000601:surgery*; D012811:Sigmoid Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: colonic neoplasm; erectile dysfunction; pelvic exenteration; rectal neoplasm; seminal vesicle