Surgical Outcome of Total Pelvic Exenteration for Primary and Recurrent Colorectal Adenocarcinomas

Background: Total pelvic exenteration (TPE) exenterative operation for primary cT4 tumor or local recurrence invited to adjacent organs in the pelvis is effective for complete resection or local control for increasing quality of life (QOL). Methods: We evaluated surgical outcomes of TPE for 13 patients with primary and recurrent colorectal adenocarcinomas in our hospital between 2005 and 2010. Results: TPE was performed for 9 patients with primary cT4 rectal adenocarcinomas and 4 with recurrent disease after colorectal surgery. The median of serum CEA level, the duration time of operation and blood loss were 38ng/ml, 681 min and 3040 ml, respectively. Complications occurred in 8 of 13 patients (62%): 3 with urinary infection, 2 with leakage, one with fistula between the ureter and the common iliac artery, one with thrombus in vena cava superior and one with fatal hemorrhaging. In 8 of 13 patients (62%) no tumor cell identified histologically at surgical margins. Recurrence developed in 4 of 8 patients with curative resection (50%): 2 with lung metastases and 2 with lymph node metastases. There was no local recurrence. In this study 3-year and 5-year overall survival rate of the patients with TPE were 80% and 42%, respectively. In patients with primary disease 5-year overall survival rate was 53% and there was significant difference compared with that in recurrent disease (p=0.0210). Conclusion: TPE is accompanied with considerable morbidity, but good local control and increasing QOL of the patients justifies the use of this procedure.