[Pelvic exenteration in advanced and or recurrent rectal cancer]

Operative procedures of pelvic exenteration which were performed on a 54 yrs male patient with irradiated rectal cancer involving the prostatic gland, perineal skin and gluteal muscles were demonstrated by cinema. Perianal fistula formation and hard fibrotic adhesion between the distal rectum and the sacrum were also seen. As a result, combined resection of the perianal skin, gluteal muscles and distal sacral bone (fourth and fifth sacral and coccygeal vertebrae) was carried out. Fifty four total pelvic exenteration were performed at National Cancer Center Hospital from 1962 to 1985. The procedures were performed as a definitive treatment for the primary tumors in 35 cases (31 males and 4 females) which corresponds to 2.7% of operated primary rectal cancer at the same period and for the locally recurrent cancer in 19 cases (13 males and 6 females). By post operative histopathological examination 35 operations, 28 of 35 primary and 7 of 19 recurrent cases, were assessed as potentially curative. Hospital death rate was 13%; i.e. 7 cases (1 of 35 primary and 6 of 19 recurrent cases). Postoperative survival rates of the 54 patients were calculated by Kaplan-Meier's method. There were 17 survivors among 35 curatively operated patients and 5 yr survival rate was 34%. On the other hand, though 6 patients are surviving, there is no long term survivor (more than 35 months) among 21 patients who were treated by palliative resection.