Total pelvic exenteration for locally advanced rectal cancer

Background: Since its first description in 1948, total pelvic exenteration has been a surgical option for die treatment of locally advanced rectal can cer in selected patients. During these 50 years, it has remained a formidab le procedure with high mortality and substantial morbidity. This report des cribes the results of total pelvic exenteration for rectal cancer in terms of postoperative mortality morbidity, and longterm survival in patients wit h locally advanced primary and recurrent rectal cancer. Study Design: A study of the patient records revealed that 24 patients unde rwent total pelvic exenteration as the treatment for locally advanced prima ry or recurrent cancer of the rectum from 1983 to 1998. The charts of the p atients were reviewed, and morbidity and mortality were documented. The sur vival of the patients was also analyzed. Results: Fifteen patients had primary tumor and 9 had locally recurrent can cer. The mean age was 62 years old. There were no postoperative deaths, and the complication rate was 54%. In the treatment of primary tumor, bowel co ntinuity was possible in 60% of the patients. Previous radiation or operati on for recurrent disease was not associated with increased morbidity. The o verall 5-year survival was 44%. The 5-year survival of patients with primar y cancer was 64% and was significantly better than the rate for those with recurrent disease. Only one patient with recurrent disease survived more th an 24 months. Conclusions: Total pelvic exenteration now can be performed with low mortal ity rates, but the morbidity remains high. In the treatment of primary rect al cancer, good survival (64%) can be achieved, but results are dismal for the treatment of recurrent disease. We suggest better selection of patients for this procedure, especially as a treatment for recurrent rectal cancer. (J Am Coll Surg 2000;190:78-83. (C) 2000 by the American College of Surgeo ns).