Outcome of total pelvic exenteration for locally recurrent rectal cancer.

摘要

BACKGROUND/AIMS: Local recurrence occurs in 10 to 30% of patients with rectal cancer following curative resection. However treatment of choice remains controversial. We assessed the results of total pelvic exenteration for locally recurrent cancer of the rectum retrospectively. METHODOLOGY: We reviewed medical charts of 45 patients with rectal cancer who underwent curative total pelvic exenteration for local recurrence. The cause of recurrence was classified into four groups: anastomotic, surgical cut-end, implantation, and lymphatic based on pathologic findings and computed tomography. Long-term survival was correlated with clinicopathologic variables. RESULTS: Postoperative morbidity was 77.8% and in-hospital death occurred in 13.3% of patients. The overall 5-year survival rate was 14.1%. The 5-year survival rates stratified according to the expectation of curability were 31.6% for absolutely curative resection, 7.8% for relatively curative resection, and 0% for non-curative resection. Multivariate analysis revealed that the disease-free interval was the only independent prognostic factor. There was no benefit from perioperative radiation or intraoperative continuous pelvic peritoneal perfusion of the pelvis. CONCLUSIONS: Total pelvic exenteration for local recurrence of rectal cancer can achieve long-term survival when curative resection is possible and the disease-free interval is long.