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10.1245/ASO.2006.03.073
Annals of Surgical Oncology 13:740-744 (2006)
© 2006 Society of Surgical Oncology
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Original Article

Is En-Bloc Resection of Locally Recurrent Rectal Carcinoma Involving the Urinary Tract Indicated?

Luca Stocchi, MD1, Heidi Nelson, MD, FACS2, Daniel J. Sargent, PhD2, Donald E. Engen, MD2 and Michael G. Haddock, MD2

1 Department of Colorectal Surgery, A30, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195
2 Division of Colon and Rectal Surgery, Gonda 9S, Mayo Clinic and Mayo Foundation, 200 First Street S.W., Rochester, Minnesota 55905

Correspondence: Address correspondence and reprint requests to: Heidi Nelson, MD, FACS; E-mail: nelson.heidi{at}mayo.edu.

Background: This study investigated morbidity, mortality, and long-term survival after multimodality management of locally recurrent rectal carcinoma involving the urinary tract.

Methods: A total of 82 patients (63 males) were identified during 1987 to 2000. Data sources were a prospectively collected database of intraoperative radiotherapy, institutional tumor registry, and chart review. The median follow-up was 3.3 years and lasted until death or for at least 2 years on all patients.

Results: A total of 20 (24%) of 82 patients had resection of urogenital tract structures without reconstruction. Sixty-two patients (76%) underwent reconstruction with ileal conduit (43%), ureteroneocystostomy (15%), or miscellaneous (18%). The mean number of fixation sites was 2.8 (SD, 1.5), and the mean number of organs at least partially resected was 2.6 (SD, 1.3). Eighty percent of patients underwent intraoperative radiotherapy among adjuvant treatments. Postoperative mortality was 2% (2 of 82), and morbidity was 39% (32 of 82), most frequently consisting of neuropathy and urinary leak (6% each). The overall 1-, 3-, and 5-year survival rates were 82%, 45%, and 19%, respectively. The median survival was 2.6 years. The number of sites involved was the only survival predictor at multivariate analysis (P < .001).

Conclusions: A multimodality approach for locally recurrent rectal carcinoma involving the urinary tract carries acceptable morbidity, mortality, and potential for long-term survival. The number of fixation sites correlates with a poorer prognosis.

Key Words: Rectal carcinoma • Local recurrence • Urinary diversion • Pelvic exenteration • Ileal conduit • Ureteroneocystostomy




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