Excision of the seminal vesicles for locally advanced and recurrent rectal and sigmoid cancer

Abstract

Background: This study aims to define the clinical and oncological outcome of ‘en-bloc’ excision of the seminal vesicles for locally advanced and recurrent tumours of the sigmoid and rectum. Methods: Eight patients were identified from a prospective colorectal cancer database at a tertiary centre as having undergone excision of the seminal vesicles in continuity with a locally advanced or recurrent sigmoid or rectal adenocarcinoma. The presentation, operative details, histopathology, oncological outcome and morbidity of the procedure were assessed. Results: Three patients were referred with recurrent tumours related to an anastomosis and five had a locally advanced sigmoid or rectal cancer. The need for resection of the seminal vesicles was determined from the preoperative pelvic magnetic resonance imaging scan or from an intraoperative finding of loss of the plane of dissection anterior to Denonvilliers' fascia. Restorative resection was achieved in all three patients where the primary tumour was located in the sigmoid or rectosigmoid, while all five patients with a rectal tumour had a permanent stoma. After a median follow-up of 43 months, seven patients are alive and disease-free and one patient has died of distant metastases. No patient has suffered a local recurrence. All five patients who were sexually active before surgery suffered from post-operative impotence. Two patients had temporary urinary retention with overflow. Conclusions: In carefully selected patients with locally advanced or recurrent rectal and sigmoid cancers that are attached to the seminal vesicles, en-bloc excision confers excellent local control but is associated with a high rate of sexual morbidity.