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

Horacio N López-Basave, Flavia Morales-Vásquez, Ángel Herrera-Gómez, Alejandro Padilla Rosciano, Abelardo Meneses-García, Juan M Ruiz-Molina

Department of Gastroenterology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico

Background: 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