Pelvic exenteration for carcinoma of the colon and rectum

Posterior pelvic exenteration for primary rectal cancer

“…Therefore, it is quite important to clearly define the indications of PPE. Direct invasion of the uterus, vagina, rectovaginal septum, cervix or Douglas pouch represented 90% of the indications in this series and others [3,5,6,[8][9][10][11][12]. The frozen pelvis, especially after pre-operative radiation, challenges the expertise of the pelvic surgeon, but it may be the only chance for cure.…”

Double‐barrelled wet colostomy with simultaneous urinary and faecal diversion: results in 9 patients and review of the literature

“…Total pelvic exenteration is a radical procedure where all pelvic organs are removed, including the uterus and appendices, the bladder, distal ureters, vagina, prostate, and rectum, in addition to the pelvic lymph nodes [1][2][3][4][5].…”

Urinary Diversion After Total Pelvic Exenteration for Rectal Cancer

“…Factors associated with an increased risk for pelvic recurrence include tumors between 0 and 11 cm from the anal verge and an increasing Dukes stage. [3][4][5][6][7][8][9] The involvement by a local tumor recurrence, or, less commonly, a bulky, primary nonmetastatic tumor of adjacent urological organs including bladder, prostate, and seminal vesicles, suggests that an exenterative operation could salvage the patient. In the late 1940s and early 1950s, surgical investigators such as Brunschwig 10 and Bricker 11 reported their initial experiences with salvage pelvic exenteration for locally recurrent pelvic cancers.…”

“…12,13 Despite four decades of experience with total pelvic exenteration for recurrent rectal cancer, as well as improvements in patient selection because of the development of CT and MRI scanning, this salvage operation remains a challenging procedure, with approximately 25% to 35% long-term survivors reported. 9 Although there are no absolute guidelines for patient selection for total pelvic exenteration for rectal cancer, it has been our practice, in general, to limit this operation to patients without evidence of extrapelvic cancer. The potential perioperative morbidity and anticipated decline in quality of life after such procedures are risks worth taking if there is a 25% to 30% chance of long-term survival.…”

“…To qualify for a total pelvic exenteration for recurrent rectal cancer, patients must be medically fit, with a performance status of more than 90%, which will increase their likelihood of surviving the perioperative period. 9,14 The purpose of the current study was to assess the urological complications related to urinary diversion at the time of total pelvic exenteration for colorectal cancer and to describe the urological surgeon's role in these procedures.…”