Indication and Prognosis of Total Pelvic Exenteration for Primary and Recurrent Rectal Cancer

During the last 13 years, thirty-six patients underwent total pelvic exenteration (TPE) for the primary far advanced and locally recurrent rectal cancer. Twenty-two of them were primary rectal cancer and another 14 were recurrent rectal cancer. Fifteen patients had radiation (30-40Gy) preoperatively (6:primary case, 9 recurrent case). The mean operative time was 9 hours in primary cases and about 13 hours in recurrent cases. The mean blood loss was 2529ml in primary cases and 6558mP in recurrent cases. Operative complications were observed more frequently in recurrent and irradiational cases. TPE combined with sacral resection was performed in 8 patients with recurrent canter. Our indication for TPE in primary and recurrent cases was as follows, TPE was performed in primary cases with invasion of trigone of the bladder, seminal vesicle and prostate, but not performed in patients with distant metastasis and intra-abdominal dissemination. In recurrent cases, TPE was done in patients with recurrence localized to the posterior pelvis, with no evidence of disease beyond the pelvis, and with good medical condition. The cumulative 5-year survival rate was 55.2% in primary cases and 48.6% in recurrent cases. The disease-free 5-year survival rate was 55.2% in primary cases and 31.1% in recurrent cases. Recurrence after TPE occurred in 7 cases of primary group, and re-recurrence occurred in 6 cases of the recurrent group. In sites of failure of these cases, distant metastasis (liver, lung, bone, etc.) were observed very frequently. In conclusion, TPE for primary far advanced rectal cancer has been carried out safely, indications that the meanins of control should be enlarged. Selected patients with recurrence of rectal cancer in the pelvic area may be relieved and returned to functional life by this procedure.