TOTAL PELVIC EXENTERATION FOR LOCALLY ADVANCED RECTAL-CARCINOMA

Total pelvic exenteration was performed in 31 patients (30 males and 1 female) who had rectal cancers involving adjoining pelvic structures. Twenty-nine patients had primary tumors and two had recurrent disease s after previous abdominoperineal resection. Preoperative irradiation was used in nine patients with fixed tumors. When performing the surgi cal procedure, we also actively employed lateral node dissection to ma ke the operation more radical. Three patients (one with primary tumor and two with recurrent) underwent the exenteration with partial sacrec tomy because of the sacral involvement and they all died of local fail ure within 15 months. The overall 5-year survival rate was 52 percent for all patients and 56 percent for those who had primary tumors. The results suggest that total pelvic exenteration with lateral node disse ction should be performed for locally advanced rectal cancer if the tu mor is not completely fixed to the pelvic wall and preoperative irradi ation should be used to convert a fixed tumor to a resectable one.