Rationale for bladder-sparing surgery in patients with locally advanced colorectal carcinoma

Outcome of Total Pelvic Exenteration for Primary Rectal Cancer

“…For example, reconstruction of the pelvic floor using absorbable mesh may be useful for preventing smallbowel obstructions. 41 Additionally, Balbay et al 42 reported that bladdersparing surgery in patients with locally advanced colorectal carcinoma involving the bladder provides a good local control rate without sacrificing survival, which should make surgery more acceptable to patients.…”

Survival in Colorectal Cancer Patients With Urinary Tract Invasion

“…5,7,[15][16][17][18][19] Positron emission tomography using fluorine-18 deoxyglucose can improve the sensitivity, specificity, and predictive accuracy of staging compared with CT staging. 11,20 Advanced colorectal cancer with adherence to, or invasion of, adjacent organs is estimated to comprise 10 percent of all primary colorectal cancers, and the involvement of the urinary system occurs in 5 percent of all patients with primary colorectal cancer. [5][6][7][8][9][10][11][12][13] The sigmoid colon is thought to be the most common primary site of colorectal carcinoma invading the urinary bladder followed by the rectum.…”

“…11,20 Advanced colorectal cancer with adherence to, or invasion of, adjacent organs is estimated to comprise 10 percent of all primary colorectal cancers, and the involvement of the urinary system occurs in 5 percent of all patients with primary colorectal cancer. [5][6][7][8][9][10][11][12][13] The sigmoid colon is thought to be the most common primary site of colorectal carcinoma invading the urinary bladder followed by the rectum. 7 The final decision to perform the treatment depends on the judgment of the surgeon based on these diagnostic modalities, and most importantly, based on the intraoperative findings.…”

“…7 The final decision to perform the treatment depends on the judgment of the surgeon based on these diagnostic modalities, and most importantly, based on the intraoperative findings. 11 Survival after an extended resection is related to the stage of the carcinoma and the ability to achieve negative margins. 12,[21][22][23][24] It often is impossible to distinguish between inflammatory and malignant adhesions at the time of a laparotomy.…”

Urinary Tract Involvement by Colorectal Cancer

“…In addition to tumor staging, CT allows localization of the ureters and confirms bilateral renal function, although it tends to overestimate the need for urinary organ resection. 8,20 Only 57 percent of patients with a mucosal abnormality at cystoscopy have bladder invasion at final pathology, 21 yet locating the vesical opening of a malignant rectovesical fistula improves identification of patients who require pelvic exenteration for adequate resection. 16 Use of MRI to evaluate rectal cancer has been somewhat restricted because of its limited availability.…”