Indian Journal of Surgical Oncology

, Volume 10, Supplement 1, pp 80–83 | Cite as

Pelvic Exenteration with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS + HIPEC) for Rectal Cancer—Case Series with Review of Literature

  • Rajesh S. Shinde
  • Rajgopal Acharya
  • Naveena AN Kumar
  • Sohan Solanki
  • Ashwin Desouza
  • Avanish SaklaniEmail author
Review Article


Incidence of synchronous peritoneal metastases (PM) in colorectal cancer is approximately 5%, with another 5% of the patients develop metachronous PM. Colorectal PM has been hypothesized to be a loco-regional disease rather than a systemic spread, and cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has been considered as a viable treatment option. Pelvic exenteration is an established treatment option for locally advanced rectal cancer, but it is associated with significant morbidity. However, there are no studies evaluating the role of such procedure probably because the majority consider it as an exclusion criterion. Here, we present our experience with three cases of locally advanced rectal cancer with PM, treated successfully with pelvic exenteration and CRS-HIPEC.


CRS HIPEC Pelvic exenteration Rectal cancer 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

For this type of study (retrospective), formal consent is not required.

Authors Statement

Exenterative surgery along with CRS + HIPEC is not performed routinely, due to advances in understanding of disease biology, perioperative care, and more effective systemic therapy; more aggressive surgeries are being offered to improve the outcomes of patients with advanced disease, which were considered non-curable previously. This is the first series describing exenteration with CRS + HIPEC from the Indian subcontinent.


  1. 1.
    Lemmens VE, Klaver YL, Verwaal VJ, Rutten HJ, Coebergh JW, de Hingh IH (2011) Predictors and survival of synchronous peritoneal carcinomatosis of colorectal origin: a population-based study. Int J Cancer 128(11):2717–2725CrossRefGoogle Scholar
  2. 2.
    Segelman J, Granath F, Holm T, Machado M, Mahteme H, Martling A (2012) Incidence, prevalence and risk factors for peritoneal carcinomatosis from colorectal cancer. Br J Surg 99(5):699–705CrossRefGoogle Scholar
  3. 3.
    Coccolini F, Gheza F, Lotti M, Virzi S, Iusco D, Ghermandi C et al (2013) Peritoneal carcinomatosis. World J Gastroenterol 19(41):6979–6994CrossRefGoogle Scholar
  4. 4.
    Franko J, Ibrahim Z, Gusani NJ, Holtzman MP, Bartlett DL, Zeh HJ III (2010) Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion versus systemic chemotherapy alone for colorectal peritoneal carcinomatosis. Cancer 116(16):3756–3762CrossRefGoogle Scholar
  5. 5.
    Meyerhardt JA, Mayer RJ (2005) Systemic therapy for colorectal cancer. N Engl J Med 352(5):476–487CrossRefGoogle Scholar
  6. 6.
    Nadler A, McCart JA, Govindarajan A (2015) Peritoneal Carcinomatosis from colon cancer: a systematic review of the data for cytoreduction and intraperitoneal chemotherapy. Clin Colon Rectal Surg 28(4):234–246CrossRefGoogle Scholar
  7. 7.
    Verwaal VJ, van Ruth S, de Bree E, van Sloothen GW, van Tinteren H, Boot H et al (2003) Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol 21(20):3737–3743CrossRefGoogle Scholar
  8. 8.
    Cashin PH, Mahteme H, Spång N, Syk I, Frodin JE, Torkzad M et al (2016) Cytoreductive surgery and intraperitoneal chemotherapy versus systemic chemotherapy for colorectal peritoneal metastases: a randomised trial. Eur J Cancer 53:155–162CrossRefGoogle Scholar
  9. 9.
    Henderson N, Polignano F (2015) PTH-312. 5 year results of radical resection and hipec for colorectal cancer peritoneal metastases. Gut 64:A546–A547Google Scholar
  10. 10.
    Quenet F, Elias D, Roca L Goere D, Ghouti L, Pocard M et al (2018) A UNICANCER phase III trial of hyperthermic intra-peritoneal chemotherapy (HIPEC) for colorectal peritoneal carcinomatosis (PC): PRODIGE 7. J Clin Oncol 36(18):1Google Scholar
  11. 11.
    van Erning FN, van Steenbergen LN, Lemmens VE, Rutten HJ, Martijn H, van Spronsen DJ et al (2014) Conditional survival for long-term colorectal cancer survivors in the Netherlands: who do best? Eur J Cancer 50(10):1731–1739CrossRefGoogle Scholar
  12. 12.
    Van Leersum NJ, Snijders HS, Henneman D, Kolfschoten NE, Gooikar GA, ten Berge MG et al (2013) The Dutch surgical colorectal audit. Eur J Surg Oncol 39(10):1063–1070CrossRefGoogle Scholar
  13. 13.
    Simkens GA, Rovers KP, Nienhuijs SW, de Hingh IH (2017) Patient selection for cytoreductive surgery and HIPEC for the treatment of peritoneal metastases from colorectal cancer. Cancer Manag Res 9:259–266CrossRefGoogle Scholar
  14. 14.
    Simkens GA, van Oudheusden TR, Braam HJ, Wiezer MJ, Nienhuijs SW, Rutten HJ, van Ramshorst B, de Hingh IH (2016) Cytoreductive surgery and HIPEC offers similar outcomes in patients with rectal peritoneal metastases compared to colon cancer patients: a matched case control study. J Surg Oncol 113(5):548–553CrossRefGoogle Scholar
  15. 15.
    Kwakman R, Schrama AM, van Olmen JP, Otten RH, de Lange-de Klerk ES, de Cuba EM et al (2016) Clinicopathological parameters in patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer metastases: a meta-analysis. Ann Surg 263(6):1102–1111CrossRefGoogle Scholar
  16. 16.
    Bacalbasa N, Balescu I (2016) Pelvic exenteration as part of cytoreductive surgery for advanced stage or relapsed ovarian cancer. Eur J Surg Oncol 42(9):S158CrossRefGoogle Scholar

Copyright information

© Indian Association of Surgical Oncology 2019

Authors and Affiliations

  • Rajesh S. Shinde
    • 1
  • Rajgopal Acharya
    • 1
  • Naveena AN Kumar
    • 1
  • Sohan Solanki
    • 2
  • Ashwin Desouza
    • 1
  • Avanish Saklani
    • 1
    Email author
  1. 1.Colorectal Services, Department of Surgical oncologyTata Memorial HospitalMumbaiIndia
  2. 2.Department of Anaesthesia and Critical CareTata Memorial HospitalMumbaiIndia

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