Quality of Life After Total Pelvic Exenteration for Local Reurrence of Rectal Cancer

Tadashi Watanabe, Katsuki Ito, Kozo Kiriyama, Masashi Yamauchi, Seiji Akiyama, Hiroshi Takagi, Shizuka Hirio*

Second Department of Surgery, Nagoya University School of Medicine
*Nishio City Hospital

Seventeen patients (8 males and 9 females) with local recurrence of rectal cancer were treated by total pelvic exenteration (TPE) combined with sacral resection. The mean operation time and blood loss were 7.3 hours and 5.580 ml, respectively. No operative death occurred, but there were four postoperative complications, a perineal abscess, and three intestinal fistulas. The impact of the treatment on the quality of life was determined by the survival rate, effect of sacral resection, stomal care, and a questionnaire given to the patients. Survival curves constructed according to the Kaplan-Meier method showed that the patients with TPE have a survival rate of about 60% in comparison with a two-year survival rate of 13% in the palliated group. Two patients are alive at 56 months and 75 months with no evidence of disease. Perineal pain was relieved and walking and sitting were not affected by sacral resection. Nine patients who were interviewed required approximetely 1 hour for urinary and colostomy stomal care. In comparison with abdominoperineal resection patients, work, social activity, and psychological state were worse for TPE patients, but in the questionnaire no difference was found in diet, sleep, and bathing, which were ranked according to a 0-4 scale. Ths procedure seems to be a reasonable treatment for palliation and for full recovery in certain patients. However early detection of local recurrence, multimodal therapy including radiotherapy and chemotherapy, and psychological therapy are required to develope a good prognosis and quality of life.

Key words
rectal cancer, local recurrance, peluic exenteration

Reprint requests
Tadashi Watanabe Second Department of Surgery, Nagoya University School of Medicine
466 Tsurumai-cho, Showa-ku, Nagoya, 466 JAPAN

Accepted
December 13, 1989

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