Total pelvic exenteration for primary locally advanced and locally recurrent rectal cancer

Eur J Surg Oncol. 2007 May;33(4):452-8. doi: 10.1016/j.ejso.2006.09.021. Epub 2006 Oct 30.


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.

MeSH terms

  • Adult
  • Aged
  • Combined Modality Therapy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / radiotherapy
  • Neoplasm Recurrence, Local / surgery
  • Neoplasm Staging
  • Pelvic Exenteration / methods*
  • Postoperative Complications
  • Prognosis
  • Proportional Hazards Models
  • Rectal Neoplasms / pathology
  • Rectal Neoplasms / radiotherapy
  • Rectal Neoplasms / surgery*
  • Survival Rate
  • Treatment Outcome