Pelvic exenteration for T4 rectal cancer: a series of 15 ressectable cases |
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Authors: | Costa Sergio Renato Pais Antunes Ricardo César Pinto Paula Raphael Paulo de Pedroso Miguel Angelo Farah José Francisco de Mattos Lupinacci Renato Arioni |
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Institution: | Servi?o de Cirurgia Geral, Oncocirurgia do Hospital do Servidor Publico Estadual de S?o Paulo, Francisco Morato de Oliveira, S?o Paulo, SP Brazil. sergiorenatopais@ig.com.br |
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Abstract: | BACKGROUND: Pelvic exenteration is the best therapeutic choice for treatment of T4 rectal cancer. Although, this operation still presents considerable mortality and high morbidity. AIM: To report on a series of 15 patients with a T4 rectal cancer at a general hospital and describe the outcomes (morbidity, mortality and long-term survival) following pelvic exenteration. METHODS: Complete follow-up data were available on 15 patients who underwent pelvic exenteration for T4 rectal cancer between 1998 and 2006. These subjects comprised seven men and eight women with a mean age of 65 years. All of them presented serious incapacitating complaints. The surgical procedures included: infraelevator exenteration (n = 6), supraelevator exenteration (n = 4), posterior exenteration (n = 3) and, posterior exenteration plus partial cystectomy and ureterectomy (n = 2). RESULTS: The mean duration of surgery was 403 minutes (280-485). The mean blood loss was 1620 mL (300-4.800). The postoperative mortality was 6,66% (n = 1). The overall rate morbidity was 53,3% (n = 8). The pathological examination showed that all resections were R0. Lymph node involvement was present in four patients (26,66 %), and all of them died due to tumor recurrence. The overall 5-year survival rate was 35,7%. CONCLUSION: In spite of its aggressive nature and high morbidity, pelvic exenteration seems justified in rectal carcinoma when the disease extends to the urinary or genital tract. This procedure may offer long-term disease control. |
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