Seven cases of pelvic exenteration combined with sacral resection for locally recurrent rectal cancer.

Local recurrence of rectal cancer following abdominoperineal resection is rarely amenable to limited resection. Carcinoembryonic antigen assay is valuable for diagnosing most recurrent rectal cancers, but it is inadequate for early detection. Pelvic computed tomography examination is very valuable for the early detection and localization of recurrence in relation to pelvic structures and can also serve as a guide in percutaneous needle biopsy of the tumor. Seven patients with deeply invading recurrent lesions underwent pelvic exenteration combined with sacral resection. The ileal segment conduit was used for ureteral urinary diversion. The mean operation time and blood loss were 8.8 hours and 6,200 ml, respectively. No operative deaths were encountered. One patient is alive 22 months postoperatively with no evidence of disease, and another patient is alive 32 months postoperatively with pelvic wall recurrence. This procedure seems a reasonable treatment for palliation and full recovery in certain patients.