CLINICAL EVALUATION OF PELVIC EXENTERATION FOR CARCINOMA OF THE LOWER COLON

Abstract

Fifteen patients with carcinoma in the lower colon had been treated at our hospital between January, 1982 and January, 1983.
Five, 4 males and 1 female, of the 15 patients had total pelvic exenteration.
The patients ranged in age from 35 to 74 years. The chief complaint was bloody stool, constipation, abdominal fullness and rectal tumor. The duration of illnesss ranged from 10 days to 25 months. Two of them had undergone colostomy before the pelvic exenteration.
The primary lesion existed in the rectum in 4 patients and in both the rectum and sigmoid colon in 1 patient. The analysis of spread patterns showed that the bladder was invaded by carcinoma in all patients; and especially in a female patient the invasion of carcinoma to the vagina and ileum appeared and two of the male patients had invasive lesions in the prostate and sigmoid colon which was aboral to the primary lesion. The operation time ranged from 310 to 695 minutes with blood loss from 800 to 5200 ml.
Histopathological study disclosed 2 cases of moderately differentiated adenocarcinoma, 3 cases of well differentiated adenocarcinoma; one of them had metastatic lesion in lymph nodes and the other one had a peritoneal invasion.
Three of the 5 patients developed minor complications. One of them died of cancer 6 months after the pelvic exenteration.
Since the results of previous reports showed that, from the 5-year survival rate, this surgical procedure with pelvic exenteration was remarkably superior to other treatments without pelvic exenteration and, as shown in the present study, operative mortality rate was markedly low, total pelvic exenteration may be useful for treatment of invasive carcinoma of the lower colon. However, further improvement in the surgical procedures would be desirable.