Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Pelvic and Sacropelvic Exenteration for Locally Advanced or Recurrent Anorectal Cancer

Pelvic and Sacropelvic Exenteration for Locally Advanced or Recurrent Anorectal Cancer Abstract • Postirradiation "fixed" anorectal tumors are often considered incurable. Since 1980, we have carried out 12 pelvic and seven sacropelvic exenterations for this problem (adenocarcinoma, 18; squamous cancer, one). Nine tumors were primary; ten were recurrent (five after an anterior resection and five after an abdominoperineal resection). Prior irradiation ranged from 3000 to 12000 rad (30 to 120 Gy). Four patients had synchronous distant metastases; three died of disease (one with local recurrence), and the fourth patient has been living with disease (distant metastasis). Fifteen patients (four with B2 tumors and 11 with Astler-Coller C2 disease) had no extrapelvic disease. One patient died of postoperative complications; two others died free of disease. Three of the 15 patients died of disease (all with local recurrence), and one has been living with disease (local recurrence). Eight (53%) of 15 patients have been living free of disease 12+ to 53+ months. The results suggest that many patients with fixed postirradiation anorectal tumors may be salvaged by aggressive surgery. (Arch Surg 1987;122:537-541) References 1. Dosoretz DE, Gunderson LL, Hedberg S, et al: Preoperative irradiation for unresectable rectal and recto-sigmoid carcinomas . Cancer 1983;52: 814-818. 2. James RD, Schofield PF: Resection of 'inoperable' rectal cancer following radiotherapy . Br J Surg 1985;72:279-281.Crossref 3. Stearns MW Jr: Diagnosis and management of recurrent pelvic malignancy following combined abdominoperineal resection . Dis Colon Rectum 1980;23:359-361.Crossref 4. Pilipshen SJ, Heilweil M, Quan SHQ, et al: Patterns of pelvic recurrence following definitive resections of rectal cancer . Cancer 1984;53: 1354-1362.Crossref 5. Brunschwig A: Complete excision of pelvic viscera for advanced carcinoma: A one-stage abdominoperineal resection with end colostomy and bilateral ureteral implantation into the colon above the colostomy . Cancer 1948;1:177-183.Crossref 6. Spratt JS, Butcher HR, Bricker EM: Exenterative Surgery of the Pelvis . Philadelphia, WB Saunders Co, 1973. 7. Wanebo HJ, Marcove RC: Abdominal sacral resection of locally recurrent rectal cancer . Ann Surg 1981;194:458-471.Crossref 8. Sugarbaker PH: Partial sacrectomy for en bloc excision of rectal cancer with posterior fixation . Dis Colon Rectum 1982;25:708-711.Crossref 9. Takagi H, Morimoto T, Kato T, et al: Diagnosis and operation for locally recurrent rectal cancer . J Surg Oncol 1985;28:290-296.Crossref 10. Morson BC, Vaughn EG, Bussey HJR: Pelvic recurrence after excision of rectum for carcinoma . Br Med J Clin Res 1963;2:13-18.Crossref 11. Hughes ESR: Results of treatment of carcinoma of colon and rectum . Br Med J Clin Res 1963;2:9-12.Crossref 12. Stevens KR, Allen CV, Fletcher WS: Preoperative radiotherapy for adenocarcinoma of the rectosigmoid . Cancer 1976;37:2866-2874.Crossref 13. Emami B, Pilepich M, Willett CC, et al: Effect of preoperative irradiation on resectability of colorectal carcinomas . Int J Radiat Oncol Biol Phys 1982;8:1295-1299.Crossref 14. Cummings BJ, Rider WD, Harwood AR, et al: Radical external beam radiation therapy for adenocarcinoma of the rectum . Dis Colon Rectum 1983;26:30-36.Crossref 15. Eckhauser FE, Lindenauer SM, Morley GW: Pelvic exenteration for advanced rectal carcinoma . Am J Surg 1979;138:411-414.Crossref 16. Ledesma EJ, Bruno S, Mittelman A: Total pelvic exenteration in colorectal disease: A 20-year experience . Ann Surg 1981;194:701-703.Crossref 17. Boey J, Wong J, Ong GB: Pelvic exenteration for locally advanced colorectal cancer . Ann Surg 1982;195:513-518.Crossref 18. Stearns MW Jr, Whiteley HW: Pelvic exenteration , in Dudley H, Pories W, Carter D (eds): Rob & Smith's Operative Surgery . Woburn, Mass, Butterworths, 1983, pp 358-365, vol 3: Alimentary Tract and Abdominal Wall: Colon, Rectum and Anus. 19. Manson PN, Corman ML, Coller JA, et al: Anastomotic recurrence after anterior resection for carcinoma: Lahey Clinic experience . Dis Colon Rectum 1976;19:219-224.Crossref 20. Cass AW, Million RR, Pfaff WW: Patterns of recurrence following surgery alone for adenocarcinoma of the colon and rectum . Cancer 1976;37: 2861-2865.Crossref 21. Gastrointestinal Tumor Study Group: Prolongation of the disease-free interval in surgically treated rectal carcinoma . N Engl J Med 1985;312: 1465-1472.Crossref 22. Kennedy HL, Langevin JM, Goldberg SM, et al: Recurrence following stapled coloproctostomy for carcinomas of the mid portion of the rectum . Surg Gynecol Obstet 1985;160:513-516. 23. Sanella NA: Abdominoperineal resection following anterior resection . Cancer 1976;38:378-381.Crossref 24. Segall MM, Goldberg SM, Nivatvongs S, et al: Abdominoperineal resection for recurrent cancer following anterior resection . Dis Colon Rectum 1981;24:80-84.Crossref 25. Polk HC, Spratt JS: Results of treatment of perineal recurrence of cancer of the rectum . Cancer 1979;43:952-956.Crossref 26. Whiteley HW, Stearns MW Jr, Learning RH, et al: Radiation therapy in the palliative management of patients with recurrent cancer of the rectum and colon . Surg Clin North Am 1969;49:381-387. 27. Dobrowsky W, Schmid AP: Radiotherapy of presacral recurrence following radical surgery for rectal carcinoma . Dis Colon Rectum 1985;28: 917-919.Crossref 28. Welch JP, Donaldson GA: Detection and treatment of recurrent cancer of the colon and rectum . Am J Surg 1978;135:505-510.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Pelvic and Sacropelvic Exenteration for Locally Advanced or Recurrent Anorectal Cancer

Loading next page...
 
/lp/american-medical-association/pelvic-and-sacropelvic-exenteration-for-locally-advanced-or-recurrent-ft6CzOcyLh
Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1987.01400170043006
Publisher site
See Article on Publisher Site

Abstract

Abstract • Postirradiation "fixed" anorectal tumors are often considered incurable. Since 1980, we have carried out 12 pelvic and seven sacropelvic exenterations for this problem (adenocarcinoma, 18; squamous cancer, one). Nine tumors were primary; ten were recurrent (five after an anterior resection and five after an abdominoperineal resection). Prior irradiation ranged from 3000 to 12000 rad (30 to 120 Gy). Four patients had synchronous distant metastases; three died of disease (one with local recurrence), and the fourth patient has been living with disease (distant metastasis). Fifteen patients (four with B2 tumors and 11 with Astler-Coller C2 disease) had no extrapelvic disease. One patient died of postoperative complications; two others died free of disease. Three of the 15 patients died of disease (all with local recurrence), and one has been living with disease (local recurrence). Eight (53%) of 15 patients have been living free of disease 12+ to 53+ months. The results suggest that many patients with fixed postirradiation anorectal tumors may be salvaged by aggressive surgery. (Arch Surg 1987;122:537-541) References 1. Dosoretz DE, Gunderson LL, Hedberg S, et al: Preoperative irradiation for unresectable rectal and recto-sigmoid carcinomas . Cancer 1983;52: 814-818. 2. James RD, Schofield PF: Resection of 'inoperable' rectal cancer following radiotherapy . Br J Surg 1985;72:279-281.Crossref 3. Stearns MW Jr: Diagnosis and management of recurrent pelvic malignancy following combined abdominoperineal resection . Dis Colon Rectum 1980;23:359-361.Crossref 4. Pilipshen SJ, Heilweil M, Quan SHQ, et al: Patterns of pelvic recurrence following definitive resections of rectal cancer . Cancer 1984;53: 1354-1362.Crossref 5. Brunschwig A: Complete excision of pelvic viscera for advanced carcinoma: A one-stage abdominoperineal resection with end colostomy and bilateral ureteral implantation into the colon above the colostomy . Cancer 1948;1:177-183.Crossref 6. Spratt JS, Butcher HR, Bricker EM: Exenterative Surgery of the Pelvis . Philadelphia, WB Saunders Co, 1973. 7. Wanebo HJ, Marcove RC: Abdominal sacral resection of locally recurrent rectal cancer . Ann Surg 1981;194:458-471.Crossref 8. Sugarbaker PH: Partial sacrectomy for en bloc excision of rectal cancer with posterior fixation . Dis Colon Rectum 1982;25:708-711.Crossref 9. Takagi H, Morimoto T, Kato T, et al: Diagnosis and operation for locally recurrent rectal cancer . J Surg Oncol 1985;28:290-296.Crossref 10. Morson BC, Vaughn EG, Bussey HJR: Pelvic recurrence after excision of rectum for carcinoma . Br Med J Clin Res 1963;2:13-18.Crossref 11. Hughes ESR: Results of treatment of carcinoma of colon and rectum . Br Med J Clin Res 1963;2:9-12.Crossref 12. Stevens KR, Allen CV, Fletcher WS: Preoperative radiotherapy for adenocarcinoma of the rectosigmoid . Cancer 1976;37:2866-2874.Crossref 13. Emami B, Pilepich M, Willett CC, et al: Effect of preoperative irradiation on resectability of colorectal carcinomas . Int J Radiat Oncol Biol Phys 1982;8:1295-1299.Crossref 14. Cummings BJ, Rider WD, Harwood AR, et al: Radical external beam radiation therapy for adenocarcinoma of the rectum . Dis Colon Rectum 1983;26:30-36.Crossref 15. Eckhauser FE, Lindenauer SM, Morley GW: Pelvic exenteration for advanced rectal carcinoma . Am J Surg 1979;138:411-414.Crossref 16. Ledesma EJ, Bruno S, Mittelman A: Total pelvic exenteration in colorectal disease: A 20-year experience . Ann Surg 1981;194:701-703.Crossref 17. Boey J, Wong J, Ong GB: Pelvic exenteration for locally advanced colorectal cancer . Ann Surg 1982;195:513-518.Crossref 18. Stearns MW Jr, Whiteley HW: Pelvic exenteration , in Dudley H, Pories W, Carter D (eds): Rob & Smith's Operative Surgery . Woburn, Mass, Butterworths, 1983, pp 358-365, vol 3: Alimentary Tract and Abdominal Wall: Colon, Rectum and Anus. 19. Manson PN, Corman ML, Coller JA, et al: Anastomotic recurrence after anterior resection for carcinoma: Lahey Clinic experience . Dis Colon Rectum 1976;19:219-224.Crossref 20. Cass AW, Million RR, Pfaff WW: Patterns of recurrence following surgery alone for adenocarcinoma of the colon and rectum . Cancer 1976;37: 2861-2865.Crossref 21. Gastrointestinal Tumor Study Group: Prolongation of the disease-free interval in surgically treated rectal carcinoma . N Engl J Med 1985;312: 1465-1472.Crossref 22. Kennedy HL, Langevin JM, Goldberg SM, et al: Recurrence following stapled coloproctostomy for carcinomas of the mid portion of the rectum . Surg Gynecol Obstet 1985;160:513-516. 23. Sanella NA: Abdominoperineal resection following anterior resection . Cancer 1976;38:378-381.Crossref 24. Segall MM, Goldberg SM, Nivatvongs S, et al: Abdominoperineal resection for recurrent cancer following anterior resection . Dis Colon Rectum 1981;24:80-84.Crossref 25. Polk HC, Spratt JS: Results of treatment of perineal recurrence of cancer of the rectum . Cancer 1979;43:952-956.Crossref 26. Whiteley HW, Stearns MW Jr, Learning RH, et al: Radiation therapy in the palliative management of patients with recurrent cancer of the rectum and colon . Surg Clin North Am 1969;49:381-387. 27. Dobrowsky W, Schmid AP: Radiotherapy of presacral recurrence following radical surgery for rectal carcinoma . Dis Colon Rectum 1985;28: 917-919.Crossref 28. Welch JP, Donaldson GA: Detection and treatment of recurrent cancer of the colon and rectum . Am J Surg 1978;135:505-510.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: May 1, 1987

References