About the book
Recent data suggest that approximately 10% of primary rectal carcinomas present with tumor invasion into adjacent organs without distant metastases. The wider application of total mesorectal excision and multimodal treatment regimens, including neoadjuvant and adjuvant therapy, have reduced the rate of local recurrence to < 8% . However, many patients with local recurrence exhibit disabling complications, including severe pain caused by bony or nervous tissue involvement, urinary obstruction, fecal obstruction or incontinence, or persistent bleeding. In patients with primary locally advanced colorectal cancer (LACRC) or locally recurrent colorectal cancer (LRCRC), en bloc excision of the tumor and/or adjacent organs, via pelvic exenteration, is often necessary to obtain a negative surgical margin.
Total pelvic exenteration implies en bloc resection of the rectum, distal colon, bladder, lower ureter, internal reproductive organs, draining lymph nodes, and pelvic peritoneum. The procedure was first described by Brunschwig in 1948 as a palliative operation for advanced cervical cancer.
Disease-free survival following salvage resection is dependent upon achieving an R0 resection margin. A clear understanding of applied surgical anatomy, appropriate preoperative planning, and a multidisciplinary approach to aggressive soft tissue, bony, and vascular resection with appropriate reconstruction is necessary.
This book will discuss technical tips, tricks, and pitfalls that may assist in managing these cancers as well as the roles of additional boost radiation and intraoperative radiation therapy in the management of such cancers.