Sphincter preserving pelvic exenteration for locally advanced rectal cancer

Purpose : Locally advanced rectal cancer (LARC) represents approximately 10% of all colorectal cancers. The achievement of R0 resection through multidisciplinary approach combining chemoradiotherapy and aggressive surgery as total or posterior pelvic exenteration is the only curative option for these patients. The preservation of the pelvic diaphragm is associated with considerably higher quality of life. Material and methods : A total of 13 patients with LARC were treated by the authors from 2008 to 2012. All of them underwent neoadjuvant chemoradiotherapy and followed-up by CT, MRI and colonoscopy for a mean period of 35 months. Early complication and recurrence rates were recorded. Two cases with sphincter preserving total pelvic exenteration (TPE) were presented in details. Results : Eleven posterior (PPE) and two TPR with preservation of urogenital and anal sphincters were performed. Clear oncologic margins were achieved in 11 patients. There were no cases with distant metastases. The two cases with total exenteration are still alive and cancer-free, 18 and 13 months after the operation, respectively. The mean survival is 20,5 months as the follow-up is still ongoing. Conclusion : The multimodal approach including pelvic exenteration surgery is the only curative option for the patients with locally advanced rectal carcinoma. The survival strongly correlates with the diseasefree interval, so the achievement of R0 resection is mandatory. The primary LARCs are associated with lower morbidity and better survival rates than the recurrences. The preservation of the pelvic diaphragm, when possible, is very important for achievement of better quality of life.