COMBINED TREATMENT OF PELVIC EXENTERATIVE SURGERY AND INTRAOPERATIVE PELVIC HYPERTHERMOCHEMOTHERAPY FOR LOCALLY ADVANCED RECTOSIGMOID CANCER - REPORT OF A CASE

A huge rectosigmoidal cancer which extended into the urinary bladder i n a 64-year-old man is herein described. The tumor occupied the pelvic and lower abdominal cavities, while the rectosigmoid was totally obst ructed. No hepatic or pulmonary metastasis was evident. The ventral an d bank sides of the peritoneum in the right lower abdomen, right commo n iliac vessels, bilateral ureters, terminal ileum, cecum, ascending c olon, and urinary bladder were all directly invaded by the tumor, but the aorta, sacrum, and lower rectum were free of cancer. Consequently, an anterior pelvic exenteration was carried out along with an heal co nduit and a right hemicolectomy. Immediately after the exenteration, i ntra-pelvic hyperthermochemotherapy was performed using a 46-47 degree s C perfusate containing 40 mu g/ml of mitomycin C (MMC) and 200 mu g/ ml of cisplatin (CDDP), for 90 min, in an attempt to prevent any furth er local recurrence. A right hemicolectomy and a permanent colostomy w ere done simultaneously with the hyperthermia treatment. After an unev entful postoperative course, the patient was prescribed adjuvant chemo therapy, i.e., two administrations of 17 mg/m(2) and 21mg/m(2) of MMC, and ten doses of 710 mg/m(2) of 5-fluorouracil (5-FU) followed by fiv e doses of 535 mg/m(2) of 5-FU. At the time of this writing, the patie nt is still alive without recurrence at 21 months after surgery.