Preliminary experience with bladder preservation for lower rectal cancers involving the lower urinary tract

Background and Objectives: The aim of this study was to evaluate the feasibility of en bloc colorectal resection combined with radical prostatectomy as an alternative to total pelvic exenteration (TPE) for patients with locally advanced rectal cancer involving the lower urinary tract organs. Methods Twenty men with primary rectal cancer clinically involving the lower urinary tract organs underwent extended colorectal resection combined with radical prostatectomy. Data were entered prospectively into a database. Oncological and functional outcomes were analyzed. Results Anal sphincter-preserving operation (SPO) with radical prostatectomy was performed in 12 patients, abdominoperineal resection with radical prostatectomy in 8, and urinary reconstruction in 16. Morbidity and mortality rates were 35.0% and 0%, respectively. Five-year overall and disease-free survival rates were 83.6% and 42%, respectively. The cumulative 5-year local recurrence rate was 20.0%. All patients with urinary reconstruction achieved good voiding function, and patients with SPO showed acceptable anal function. Conclusions For lower rectal cancers involving lower urinary tract, en bloc rectal resection combined with radical prostatectomy appears oncologically acceptable and can reduce the number of TPEs.