Pelvic Exenteration in Rectal Cancer

• Published in: Turkish journal of colorectal disease Vol. 32; no. 2; pp. 85 - 97
• Main Authors: Sökmen, Selman, Manoğlu, Berke, Bişgin, Tayfun
• Format: Journal Article
• Language: English; Turkish
• Published: Mersin Galenos Publishing House 01.06.2022
• Subjects: Colorectal cancer; Mortality
• ISSN: 2536-4898; 2536-4901
• DOI: 10.4274/tjcd.galenos.2021.2021-12-8

Primary rectal cancer can recur loco-regionally in the pelvic compartment despite multidisciplinary treatment being given and oncological principles of total mesorectal excision being instituted. Recurrent disease in the tumor bed exhibits special characteristics in terms of pelvic location, tumoral extent, and extra-pelvic metastatic status. The effective treatment of this heterogeneous tumor family depends on adequate staging, skillset for doing multi-organ resection, logical usage of adjuvant chemoradiotherapy, and crucial decision-making by the tumor board. For many years, the surgical community was reluctant to perform these radical, aggressive exenterative surgical interventions due to high morbity/mortality and technical difficulties. However, in solid tumor surgery, because of the proven independent and robust prognostic association between complete tumor resection and overall survival, the number of centers doing radical pelvic exenteration in properly selected patients has gradually increased in the last 10 years. With the aid of modern technology, advances in pelvic oncologic surgery and anesthesiology, and optimum patient care, the morbity and mortality rate has decreased and overall survival has increased. Advanced age, uncontrollable co-morbidities, refractory to medical treatment, multi-organ resection, septic complications, and a lack of surgical experience are powerful prognosticators. Research into this complex surgical field in terms of colorectal cancer is still ongoing.