Andreas M. Kaiser is the Assistant Professor of Clinical Surgery.
Preservation of bowel and urinary continence in the management of locally recurrent rectal cancer
Article first published online: 22 SEP 2005
Copyright © 2005 Wiley-Liss, Inc.
Journal of Surgical Oncology
Volume 92, Issue 1, pages 76–81, 1 October 2005
How to Cite
Wasserberg, N., Kaiser, A. M., Nunoo-Mensah, J. W., Biernacki, P., Kleisli, T. and Beart, R. W. (2005), Preservation of bowel and urinary continence in the management of locally recurrent rectal cancer. J. Surg. Oncol., 92: 76–81. doi: 10.1002/jso.20371
- Issue published online: 22 SEP 2005
- Article first published online: 22 SEP 2005
- Manuscript Accepted: 5 JUL 2005
- Manuscript Received: 6 MAR 2005
- rectal cancer;
- recurrent cancer;
- pelvic exenteration;
- continence restoration
The management of locally recurrent rectal cancer should achieve local tumor control and potentially improving disease-free and overall survival. Radical pelvic resection has traditionally been associated with permanent fecal and urinary diversion. However, as advanced techniques have evolved to allow restoration of intestinal and urinary continence, we reviewed the use of these techniques in patients with recurrent rectal cancer.
Patients with recurrent rectal cancer who underwent a resection at Norris Comprehensive Cancer Center between 1993 and 1999 were retrospectively reviewed. Data collected included demographic data, surgical and oncological history, patterns of recurrence, treatment modalities, and outcome. Follow-up data was obtained from the last clinic visit and/or tumor registry.
Sixty-seven patients with locally recurrent rectal cancer (male/female 45/22, age 32–81 years) were included in the analysis. Continence was re-established in 22 (33%) patients, urinary continence was restored in 12 patients, and intestinal continuity in 14 patients (both in 4 patients). A temporary diverting ostomy was necessary in 5 out of 14 (36%) patients. Mortality was zero and morbidity was low and included two urinary leaks and one fecal leak all of which could be managed non-operatively. At a median follow-up of 16 months (range 5–55), 11 (50%) patients were still alive, 7 (31%) without evidence of disease. Comparison of the groups of patients either with or without continence preservation showed no statistically significant difference in disease-free survival and overall survival rates. High quality of life was achieved with restoration of continuity, no patient with restored continuity expressed a desire for a diversion.
If an oncologically adequate resection of the recurrent rectal cancer can be performed without impairment of the pelvic floor integrity, continence preservation is feasible and results in good functional and oncological outcome. J. Surg. Oncol. 2005;92:76–81. © 2005 Wiley-Liss, Inc.