Abstract

Purpose : Total pelvic exenteration (TPE) is the standard surgical procedure for patients with advanced low rectal cancer involving lower urinary tract organs such as the prostate and the urethras. We evaluated the feasibility of bladder and anus-sparing surgery as an alternative to TPE. Methods : Sixteen patients with advanced lower rectal cancer, involving involving the prostate and seminal vesicles or the urethral, underwent bladder-sparing extended rectal resection with radical prostatectomy. The anus-preserving was also performed using intersphincteric resection (ISR) or very low anterior resection, if possible. These sixteen patients were general candidates for TPE. Oncologic outcomes and postoperative urinary and anal functions were estimated. Results : The surgical proadures were ISR with radical prostatectomy (n=9), very low anterior resection with radical prostatectomy (n=1), and abdominoperineal resection (APR) with radical prostatectomy (n=6). Cyst-urethral anastomosis (CUA) was performed in twelve patients, four patients received cystostomy on suspicion of cancerous invasion to the membranous urethral. Anal sphincter-preserving surgery was done in ten patients (Colo-anal anastomosis : 9, colo-anal canal anastomosis : 1). All patients had cancer-free surgical margins. There was no mortality. After a median follow-up period of 34 months, ten patients were alive without disease and three were alive with distant metastasis, although local recurrence was developed in two patients and distant metastasis in six. Twelve patients with CUA had satisfactory voiding function, and seven with preserving anus had acceptable bowel function after diverting stoma closure. Conclusions : These procedures as an alternative to TPE may yield improved postoperative functions without compromising oncologic outcomes.

Recommended Citation

Norio Saito (2008) "Function Preserving Surgery for lower rectal cancer involving lower urinary tract in male patients.," World Journal of Colorectal Surgery: Vol. 1 : Iss. 1, Article 11.
Available at: http://services.bepress.com/wjcs/vol1/iss1/art11