[Posterior pelvic exenteration in locoregional recurrence of rectal carcinoma--indications, technique and outcome].

Despite a potentially curative operation in over 70% of rectal carcinomas, local recurrence is observed in up to 55%. The most common location is at or around the anastomosis and the presacral region. Locoregional recurrence is--apart from distant metastases--the most important factor determining prognosis and survival. If an R0 resection can be performed, a 5-year survival rate of 20-30% can be achieved. Whether patients will benefit from a palliative operation is still a matter of debate. Morbidity is estimated to exceed 60% and perioperative mortality always below 10%. In this article, we review the indication, preoperative diagnostic and therapeutic procedures as well as results of the posterior pelvic exenteration with sacral resection. Taking all aspects into account, posterior pelvic exenteration seems to be justified due to the lack of alternatives and the potential benefit of palliative and curative resection. With respect to the effort in time, personnel, surgical expertise and logistics, this operation should be preferably performed in specialized and well-equipped medical institutions.