PELVIC EXENTERATION FOR RECURRENT AND EXTENSIVE PRIMARY COLORECTAL ADENOCARCINOMA

Background. Local failure after curative surgery for colorectal adenoc arcinoma remains a major source of morbidity and mortality. This retro spective analysis reviews the authors' experience with pelvic exentera tion in the setting of recurrent and locally advanced colorectal cance r. Methods. Between 1979 and 1986, 50 pelvic exenterations were perfor med for recurrent (43) and primary (7) colorectal pelvic malignancies. Of these, 30 patients were operated on with curative intent, whereas 20 underwent operation for palliation of intractable pain, sepsis, fis tula, bleeding, or bowel obstruction. Twenty-six patients had received radiation to 4000 cGy or more. Of the recurrent tumors, the median ti me from primary treatment to exenteration was 39.7 months. Results. Po stoperative mortality included 7 in-hospital deaths (14%): 5 of 20 in the palliative group and 2 of 30 in the curative group. Complications were common (a total of 71 occurrences), but there has been a signific ant decrease with experience. The median survival was 19 months for th e curative group and 10 months for the palliative group, excluding per ioperative mortality. The 5-year survival was 6% overall, and 10% for the curative group. Eighty-nine percent of patients in the curative gr oup had significant pain relief (71% complete, 18% partial), whereas 6 7% of those in the palliative group had complete or partial pain contr ol. Conclusions. Long-term survival after pelvic exenteration for recu rrent colorectal carcinoma is uncommon (2/43), but sustained palliatio n and local control can be achieved with acceptable morbidity and mort ality in most patients with intractable pelvic symptoms.