Abstract
There are over 14,000 newly diagnosed rectal cancers per year in the United Kingdom of which between 50 and 64 percent are locally advanced (T3/T4) at presentation. Pelvic exenterative surgery was first described by Brunschwig in 1948 for advanced cervical cancer, but early series reported high morbidity and mortality. This approach was later applied to advanced primary rectal carcinomas with contemporary series reporting 5-year survival rates between 32 and 66 percent and to recurrent rectal carcinoma with survival rates of 22–42%. The Swansea Pelvic Oncology Group was established in 1999 and is involved in the assessment and management of advanced pelvic malignancies referred both regionally and UK wide. This paper will set out the selection, assessment, preparation, surgery, and outcomes from pelvic exenterative surgery for locally advanced primary rectal carcinomas.
Highlights
There are over 14,000 newly diagnosed rectal cancers per year in the United Kingdom [1] of which between 50 and 64 percent are locally advanced (T3/T4) at presentation [2, 3]
The aim of this paper is to set out the criteria for selection of patients suitable for radical treatment of primary locally advanced rectal carcinoma to offer the possibility of cure
These include total pelvic exenteration (TPE) for tumours of the rectum involving the bladder in the male or the hysterectomised female patient, posterior pelvic exenteration (PPE) for female patients in which the rectal tumour has invaded anteriorly into the uterus, cervix, or proximal vagina, or a rectal excision with en bloc prostatectomy for low rectal tumours solely invading the posterior aspect of the prostate without bladder involvement; in these cases a radical prostatectomy is undertaken with immediate bladder reconstitution
Summary
There are over 14,000 newly diagnosed rectal cancers per year in the United Kingdom [1] of which between 50 and 64 percent are locally advanced (T3/T4) at presentation [2, 3]. Pelvic exenterative surgery was first described by Brunschwig in 1948 [4] for advanced cervical cancer, but early series reported high morbidity and mortality. This approach was later applied to advanced primary rectal carcinomas with contemporary series reporting 5-year survival rates between 32 and 66 percent [5, 6] and to recurrent rectal carcinoma with survival rates of 22–42% [7]
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