A 10-year experience of total pelvic exenteration for primary advanced and locally recurrent rectal cancer based on a prospective database

Aim The study was conducted in a dedicated centre treating the majority of Danish patients with intended curative total pelvic exenteration for primary advanced (PARC) or locally recurrent (LRRC) rectal cancer. We compared PARC and LRRC and analysed postoperative morbidity and mortality, and long‐term outcome. Method There were 90 consecutive patients (PARC/LRRC 50/40) treated between January 2001 and October 2010, recorded on a prospectively maintained database. Results The median age was 63 (32–75) years with a gender ratio of 7 women to 83 men. All patients were American Society of Anesthesiologists level I or II. Sacral resection was performed in five patients with PARC and 15 with LRRC (P = 0.002). R0 resection was achieved in 33 (66%) patients with PARC and in 15 (38%) with LRRC, R1 resection in 17 (34%) with PARC and 20 (50%) with LRRC and R2 resection in five (13%) with LRRC. R0 resection was more frequent in PARC (P = 0.007). Forty‐four (49%) patients had no postoperative complications. Fifty‐five major complications were registered. Two (2.2%) patients died within 30 days, and the total in‐hospital mortality was 5.6%. The median follow‐up was 12 (0.4–91) months. The 5‐year survival was 46% for PARC and 17% for LRRC (P = 0.16). Conclusion Pelvic exenteration is associated with considerable morbidity but low mortality in an experienced centre. Pelvic exenteration can improve long‐term survival, especially for patients with PARC. However, pelvic exenteration is also justified for patients with LRRC.