Genitourinary tract preservation versus pelvic exenteration for advanced colorectal tumors

Total pelvic exenteration (TPE) is the standard of care for locally advanced colorectal cancer. This is a morbid procedure often leaving the patient with two ostomy sites and an extended recovery. Bladder preservation with complete tumor resection is often possible in these cases and we set out to determine if limited resection of the GU tract was as effective in tumor control as TPE.

This is a retrospective review of all patients over a 7-year period with colorectal tumors invading the urinary system. These patients were divided into two groups based upon the surgical procedure they received: TPE or GU tract sparing surgery. Tumor stage, adjuvant cancer therapy, and complications were reviewed. Recurrence and survival rates were calculated.

There were 19 patients with colorectal tumors invading the GU tract. Eight patients were treated with TPE and 11 patients received GU tract sparing procedures. Tumor stage and extent of disease were similar for both groups as were adjuvant/neoadjuvant therapy received. The average follow up from surgery for TPE and GU tract sparing procedures was 40 months (range 9 - 96) and 53 months (range 21.5 - 94), respectively. The limited resection and TPE groups experienced similar complication rates: 7/11 (63.6%) and 6/8 (75%) respectively. The 5-year survival rate was 37.5% and 61.4% for TPE and limited GU resections, respectively (p=0.07).

The cancer recurrence and complication rates were similar in both groups offering no clear advantage to TPE. GU sparing surgery in the face of locally invasive colorectal tumors is a viable option allowing for treatment of the disease and reducing the morbidity of total pelvic exenteration.