Surgery for recurrent rectal adenocarcinoma in the presence of hydronephrosis

From January 1974 to December 1989, 16 patients with locally recurrent rectal adenocarcinoma and hydronephrosis underwent exploratory celiotomy with curative intent. There were eight males and eight females. The median age was 61 years. Primary rectal adenocarcinomas were treated with abdominoperineal resection in 12 patients and low anterior resection in 4 patients. Four patients underwent adjuvant radiotherapy, one patient adjuvant chemotherapy, and one patient combination therapy. The median disease-free interval between resection of the primary tumor and recurrence was 18 months. Hydronephrosis was unilateral in seven patients (44%), and bilateral in nine patients (56%). Preoperative evaluation indicated that all 16 patients had local pelvic-perineal recurrence or pelvic recurrence alone. Resection was not possible in any of these 16 patients for the following reasons: 5 patients (31%) had pelvic sidewall involvement and carcinomatosis; 3 patients (19%) pelvic sidewall involvement alone; 2 patients (13%) pelvic sidewall involvement and sacral fixation; and 2 patients (13%) had sacral fixation alone. In the remaining four patients, there was pelvic sidewall involvement by tumor and/or synchronous hepatic metastases, carcinomatosis, or sacral fixation. The median survival after exploratory celiotomy was 8 months in the 16 patients who died of their disease. Unilateral and bilateral hydronephrosis appears to be a contraindication for potentially curative surgical resection in recurrent rectal adenocarcinoma.