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 2 mm. 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.

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European Journal of Surgical Oncology
Erasmus MC: University Medical Center Rotterdam

Vermaas, M., Ferenschild, F., Verhoef, K., Nuyttens, J., Marinelli, A., Wiggers, T., … de Wilt, J. (2007). Total pelvic exenteration for primary locally advanced and locally recurrent rectal cancer. European Journal of Surgical Oncology, 33(4), 452–458. doi:10.1016/j.ejso.2006.09.021