Pelvic exenteration for colorectal cancer: oncologic outcome in 59 patients at a single institution

Abstract

Horacio N López-Basave, Flavia Morales-Vásquez, Ángel Herrera-Gómez, Alejandro Padilla Rosciano, Abelardo Meneses-García, Juan M Ruiz-MolinaDepartment of Gastroenterology, Instituto Nacional de Cancerología (INCan), Mexico City, MexicoBackground: Pelvic exenteration (PE) continues to be the only curative option in selected patients with advanced or recurrent pelvic neoplasms. A current debate exists concerning the appropriate selection of patients for PE, with the most important factor being the absence of extrapelvic disease.Aim: To evaluate the outcome of patients submitted to exenterative surgery.Patients and methods: A review of the clinical charts of patients with colorectal cancer who underwent PE between January 1994 and June 2010 at the Institute National of Cancerología in Mexico City was performed.Results: We selected 59 patients, 53 of whom were females (90%), and six of whom were males (10%). Mean age at the time of diagnosis was 50 years (range, 21-77 years). A total of 51 patients underwent posterior PE (86%), and eight patients underwent total PE (14%). Operative mortality occurred in two cases (3%), and 29 patients developed complications (49%). Overall, 11 patients (19%) experienced local failure with mean disease-free survival time of 10.2 months. After a mean follow-up of 28.3 months, nine patients are still alive without evidence of the disease (15%).Conclusions: PE should be considered in advanced colorectal cancer without extrapelvic metastatic disease. PE is accompanied by considerable morbidity (49%) and mortality (3%), but local control is desirable. Overall survival justifies the use of this procedure in patients with primary or recurrent locally advanced rectal cancer.Keywords: pelvic exenteration, colorectal cancer