MORBIDITY AND MORTALITY FOLLOWING PREOPERATIVE RADIATION-THERAPY AND TOTAL PELVIC EXENTERATION FOR PRIMARY RECTAL ADENOCARCINOMA

Background: Pelvic exenteration, the standard treatment for patients w ith locally advanced rectal adenocarcinoma infiltrating neighbouring p elvic visceras, carried a significant morbidity and mortality rate. Ai ms: The aim of this study was to determine the morbidity and mortality rates in a group of patients who were treated with preoperative radia tion therapy and total pelvic exenteration. Methods: Between January 1 980 and January 1995, we treated 18 patients. Pretreatment staging was determined by clinical examination and computed tomography (CT) scan of the abdomen and pelvis. Each patient received preoperative radiatio n therapy of 45 Gy in 20 fractions delivered to the whole pelvis; appr oximately 6 weeks later total pelvic exenteration was performed. Resul ts: There were 17 males and 1 female, with a median age of 59 years. A ll patients underwent and completed the scheduled radiation therapy tr eatment. The main complaints related to radiotherapy were transient sk in erythema in five patients and diarrhoea in four. Blood loss (estima ted by the surgeon) ranged from 1000 ml to 4200 ml, with a mean loss o f 2020 ml. Eight patients (44%) developed major complications: anastom atic leak from the uretero-intestinal suture line (n=1); perineal woun d infection (n=2); abnormal wall infection (n=1); haemorrhage from the right internal iliac vein (n=1) and pneumonia (n=1). Three patients r equired surgical reintervention for immediate postoperative haemorrhag e from the sacral venous plexus (n=1), small bowel obstruction (n=1), and intra-abdominal and pelvic abscess (n=1). There were two postopera tive deaths (11%). The mean and median follow-up was 41 and 32 months, respectively. Two patients (12%) developed local recurrence at 5 and 8 months, and six developed distant recurrences (37%). The overall 5-y ear survival rate was 61%. Conclusion: Our treatment approach was asso ciated with high morbidity and mortality rates, but was similar to pre viously published series based on total pelvic exenteration without pr ior radiation therapy. In addition, our therapeutic approach was assoc iated with a low rate of overall local recurrences.