TOTAL PELVIC EXENTERATION WITH OR WITHOUT SACRAL RESECTION IN PATIENTS WITH RECURRENT COLORECTAL-CANCER

Pelvic recurrence from colorectal cancer produces significant morbidit y. Radiation can help palliate the pain produced by this recurrence. F requently patients with recurrent colorectal cancer will progress to a constant unrelenting pain and obstructive uropathy with sacral and bl adder in involvement. These patients can be candidates for an aggressi ve surgical resection with the hope of significant palliation and prol onged survival. From October 1988 to December 1991, six patients had t otal pelvic exenteration at our institution. Of these six patients, tw o had en bloc sacral resection at levels S1-S2 and one at S2-S3. Two p atients had residual disease at the time of primary surgery, and in th e other four patients, recurrence occurred 7 to 48 months after primar y resection. One patient died with disease at 7 months, and five patie nts are alive at 9, 25, 25, 37, and 37 months since the pelvic resecti on; four have no evidence of disease. The present Karnofsky performanc e status is 80% or greater in all patients. There were no operative de aths. Of the five living patients, the survival from diagnosis of the primary lesion is 25 to 97 months. Total pelvic exenteration and abdom ino-sacral exenteration can produce significant palliation and prolong survival in a selected group of patients with pelvic recurrence from colorectal cancer.