骨盤内臓器全摘術症例の検討 適応についての考察

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  • STUDIES ON TOTAL PELVIC EXENTERATION (TPE) FOR RECTAL CANCER INDICATIONS FOR TPE

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Fifteen of our 20 cases of total pelvic exenteration (TPE) for primary or recurrent rectal cancer were reviewed.<br> Although we performed TPE in 5 cases in anticipation of non-curative operation, one patient with distant lymph node metastasis (N4) has survived for 3 years 3 months, another with synchronous metastasis to liver and lung survived for 4 years 6 months, and the others with liver metastasis survived for 2 years 5 months, 12 months, and 8 months.<br> All patients who underwent curative operation have survived for less than 6 years and 5 months, except one who died of liver metastasis after 1 year 7 months, and another who died of meningitis cartinomatosa after a month. Then overall 5-year survival rate is 52.8%, and in the curative operation group, 80%.<br> Ileal conduits were used to reconstruct the urinary tract in 12 cases and a Cockpouch in 3 cases; all patients with a Cockpouch are alive yielding a higher quality of life (QOL).<br> Indications for TPE should be considered seriously because of the operative burden and postoperative QOL. However, since good efficacy in prolonging life and good control of local disease can be obtained in non-curative cases, more active indications for TPE and innovations to improve QOL, such as reconstruction of the urinary tract, are considered necessary.

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