Extensive en bloc resection of regionally recurrent carcinoma of the rectum.

To remove regionally recurrent cancer of the rectum completely, more radical extensive resections were attempted than the conventional ones in 35 patients. Twenty-two patients underwent total pelvic exenteration. In 23, sacral resection was done, combined with other procedures including excision of the entire circumference of the lower pelvic ring. There were two hospital deaths. Delayed wound healing was seen in ten. Preoperative severe pain was alleviated in 18. Also, perineal ulcer, vaginal bleeding, bloody stools, and tenesmus disappeared. Of the four 5-year survivors (estimated rate, 23%), only one was disease-free. A second recurrence was seen in 27 patients, of whom 23 had regional failure. It was concluded that so-called local recurrence is a lesion more widespread than indicated by imaging and biopsy. Therefore, even the most radical resection rarely can cure this disease. However, such a surgical procedure can afford more effective palliation than other treatments and may prolong life in selected patients significantly.