Total pelvic exenteration with or without sacral resection in patients with recurrent colorectal cancer

Pelvic recurrence from colorectal cancer produces significant morbidity. Radiation can help palliate the pain produced by this recurrence. Frequently patients with recurrent colorectal cancer will progress to a constant unrelenting pain and obstructive uropathy with sacral and bladder involvement. These patients can be candidates for an aggressive surgical resection with the hope of significant palliation and prolonged survival. From October 1988 to December 1991, six patients had total pelvic exenteration at our institution. Of these six patients, two had en bloc sacral resection at levels S1-S2 and one at S2-S3. Two patients had residual disease at the time of primary surgery, and in the other four patients, recurrence occurred 7 to 48 months after primary resection. One patient died with disease at 7 months, and five patients are alive at 9, 25, 25, 37, and 37 months since the pelvic resection; four have no evidence of disease. The present Karnofsky performance status is 80% or greater in all patients. There were no operative deaths. Of the five living patients, the survival from diagnosis of the primary lesion is 25 to 97 months. Total pelvic exenteration and abdomino-sacral exenteration can produce significant palliation and prolong survival in a selected group of patients with pelvic recurrence from colorectal cancer.