• Johan N Wiig, Jan P Poulsen, Stein Larsen, Morten Braendengen, Håkon Waehre, and Karl-Erik Giercksky.
• Department of Surgical Oncology, The Norwegian Radium Hospital, Oslo, Norway.
• Eur J Surg. 2002 Jan 1; 168 (1): 42-8.

ObjectiveTo study the complication rate, local recurrence rate, and survival after total pelvic exenteration for primary advanced and recurrent rectal cancer.DesignProspective study.SettingTertiary referral university hospital, Norway.Subjects25 patients who were operated on for primary advanced and 22 for recurrent rectal cancer since 1991; 42 men and 5 women, mean age 64 years (range 44-78). All had preoperative irradiation of 46-50 Gy.Main Outcome MeasuresIncidence of major complications, and actuarial 5-year survival and local recurrence rate.ResultsTwenty patients had RO resection in the primary group versus seven in the recurrent group. No R2 resections were done in the primary group compared with four in the recurrent group. Half the primary cases (n = 13) had abdominoperineal resections. Hartmann's procedures were common in both groups (n = 8 in each). Postoperative mortality at 30 days was 4% (n = 2) and in-hospital 13% (n = 6). 18 patients had major complications and 12 were reoperated on. Overall 5-year actuarial survival for 43 patients without distant metastases was 28%-those with primary tumours 36%, and those with recurrent tumours 18%-similar to the figures for RO and R1 resections. Actuarial local recurrence at 5 years for primary cancers was 18% compared with 68% for recurrent cancers, again nearly identical to the figures for R0/R1 operations (p = 0.008 and p = 0.03).ConclusionSome patients with advanced rectal cancer either primary or recurrent may benefit from simultaneous en-bloc cystectomy. The higher postoperative morbidity and mortality indicate the need for well-defined indications for this procedure and the necessity for thorough preoperative staging.

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