[Pelvic exenteration combined with sacral resection for recurrent rectal cancer. The roles of carcinoembryonic antigen and pelvic computed tomography for early detection].

Local recurrence of rectal cancer following abdominoperineal resection is rarely amenable to limited resection. CT study of the pelvis revealed recurrent tumor images in relation to the adjacent pelvic structures. Six patients with deeply invading recurrent lesions were subjected to pelvic exenteration combined with sacral resection. No postoperative deaths were encountered. The postoperative sharp drops of serum CEA levels are useful for judging the adequacy of this procedure. The follow-up status of the 6 patients is as follows, respectively: 16 months dead from pulmonary & hepatic metastasis, 11 months and 9.5 months alive without symptoms but with slightly elevated CEA level, and 5 months, 2 months and 2 weeks alive with no evidence of disease. All patients who were relieved of perineal or sciatic nerve pain are now able to walk without any assistance or trouble. Total en bloc residual pelvic exenteration combined with sacral resection is a reasonable treatment for locally recurrent rectal cancer.