Total pelvic exenteration for primary locally advanced and locally recurrent rectal cancer

Vermaas, M.; Ferenschild, F.T.J.; Verhoef, C.; Nuyttens, J.J.M.E.; Marinelli, A.W.K.S.; Wiggers, T.; Kirkels, W.J.; Eggermont, A.M.M.; de Wilt, J.H.W.

doi:10.1016/j.ejso.2006.09.021

« Previous Next »European Journal of Surgical Oncology
Volume 33, Issue 4 , Pages 452-458, May 2007

Total pelvic exenteration for primary locally advanced and locally recurrent rectal cancer

M. Vermaas
- Department of Surgical Oncology, Erasmus MC – Daniel den Hoed Cancer Center, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands
F.T.J. Ferenschild
- Department of Surgical Oncology, Erasmus MC – Daniel den Hoed Cancer Center, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands
C. Verhoef
- Department of Surgical Oncology, Erasmus MC – Daniel den Hoed Cancer Center, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands
J.J.M.E. Nuyttens
- Department of Radiotherapy, Erasmus MC – Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
A.W.K.S. Marinelli
- Department of Surgical Oncology, Erasmus MC – Daniel den Hoed Cancer Center, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands
- Present address: Medisch Centrum Haaglanden, Den Haag, The Netherlands.
T. Wiggers
- Department of Surgical Oncology, Erasmus MC – Daniel den Hoed Cancer Center, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands
- Present address: Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
W.J. Kirkels
- Department of Urology, Erasmus MC – Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
A.M.M. Eggermont
- Department of Surgical Oncology, Erasmus MC – Daniel den Hoed Cancer Center, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands
J.H.W. de Wilt
- Department of Surgical Oncology, Erasmus MC – Daniel den Hoed Cancer Center, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands
- Corresponding author. Tel.: +31 10 4391232; fax: +31 10 4391011.

Accepted 21 September 2006.

Abstract

Aims

To report the role of total pelvic exenteration in a series of locally advanced and recurrent rectal cancers.

Methods

In the period 1994–2004, TPE was performed in 35 of 296 patients with primary locally advanced and recurrent rectal cancer treated in the Daniel den Hoed Cancer Center; 23 of 176 with primary locally advanced and 12 of 120 with recurrent rectal cancer. All but one patient received pre-operative External Beam Radiation Therapy (EBRT). After 1997, Intra Operative Radiotherapy (IORT) was performed in case of a resection margin less than 2mm.

Results

Overall major complication rates were not significantly different between patients with primary and recurrent rectal cancer (26% vs. 50%, p=0.94). The hospital mortality rate was 3%. The 5-year local control and overall survival of patients with primary locally advanced rectal cancer were 88% and 52%, respectively. In patients with recurrent rectal cancer 3-year local control and survival rates were 60% and 32%, respectively. An incomplete resection, preoperative pain and advanced Wanebo stage for recurrent cancer were negative prognostic factors for both local control and overall survival.

Conclusion

TPE in primary locally advanced rectal cancer enables good local control and acceptable overall survival, thereby justifying the use of the procedure. Patients with recurrent rectal cancer showed a high rate of major complications, a high distant metastasis rate, and a poor overall survival.

Keywords: Pelvic, Exenteration, Locally advanced, Rectal, Cancer