Pelvic Exenteration for Primary Rectal Carcinoma

Hideyuki Ike, Sigeo Ohki, Shigeki Yamaguchi, Shinichi Ishihara, Hidenobu Masui, Hirotoshi Akiyama, Shouichi Fujii, Masao Nanko, Hiroshi Shimada

Second Department of Surgery, Yokohama City University School of Medicine

A retrospective analysis of cases with pelvic exenteration for primary rectal carcinoma at the Second Department of Surgery, Yokohama City University, was carried out in terms of survival rate, recurrence rate and mode of recurrence. The 5-year survival rate of 58 patients who underwent curative exenteration was 67.1%, and the recurrence rate was 32.1%. Local recurrence occurred in 8 patients and liver metastasis in 4 patients. Local recurrence occurred more frequently in cases with depth a2 or more and positive ly'rnph node metastasis. Liver metastasis occurred more frequently in the patients with upper rectum than lower rectum and positive lymph node metastasis. In order to reduce recurrence, since December 1992 we have employed pelvic exenteration with continuous hyperthermic peritoneal perfusion in the pelvis (CHPPP) using CDDP, MMC and 5FU, continuous hepatic arterial infusion of CDDP and 5 FU, continuous portal infusion of 5FU, combined resection of the internal iliac vessels and combined resection of the distal sarcrum for advanced rectal carcinoma with other organ involvement. Six patients with these adjuvant therapies obtained curative resection histologically. Excluding 1 case who died of acute renal failure, no recurrence was found for 16 months after the operation. Pelvic exenteration with these adjuvant therapies was considered useful for the improvement of survival rate and reduction of recurrence rate.

Key words
rectal carcinoma, pelvic exenteration, continuous hyperthermic peritoneal perfusion in the pelvis

Reprint requests
Hideyuki Ike Second Department of Surgery, Yokohama City University School of Medicine
3-9 Fukuura, Kanazawa-ku, Yokohama, 236 JAPAN

Accepted
July 6, 1994

To read the PDF file you will need Abobe Reader installed on your computer.