title: Bowel and bladder continence, wound healing, and functional outcomes in patients who underwent sacrectomy.
abstract: OBJECTIVE
  Total or partial sacrectomy is a rare procedure in patients with locally invasive tumors involving the sacrum; it may be associated with functional loss, such as bowel and bladder dysfunction and gait abnormality. In this study the authors examined functional outcome following sacrectomy.
  
  
  METHODS
  The authors reviewed the charts of 50 consecutive patients who had undergone sacrectomy between July 1993 and August 2002. There were 23 male and 27 female patients whose mean age was 46 years (range 13-86 years). Twelve patients with rectal cancer underwent a separate analysis. The patients without rectal cancer were divided into two groups: those who had undergone colostomy for bowel diversion (Group 1, six cases), and those who had not (Group 2, 32 cases). In Group 1 patients the median hospital length of stay (LOS) was 48.5 days (the 25th% and 75th percentiles are 26 and 58, respectively), and in Group 2 patients the median LOS was 18.5 days (the 25th and 75th percentiles are 8 and 41, respectively; p = 0.14). In Group 2 (non-rectal cancer without colostomy), LOS was greater in patients in whom a myocutaneous flap was used compared with those in whom no flap was used (36 days compared with 8.5 days, respectively; p = 0.0012); in patients with bowel incontinence the median LOS was significantly longer than that in patients with bowel continence (39 days compared with 8 days, respectively; p = 0.0026). The incidence of bowel incontinence in Group 2 was closely related to the integrity of the S-3 nerve root (p = 0.05).
  
  
  CONCLUSIONS
  Awareness of the association between S-3 nerve root resection and bowel and bladder incontinence may help surgeons' decision-making process.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. yguo@mdanderson.org
authors.forename: Ying
authors.initials: Y
authors.lastname: Guo
authors.forename: J Lynn
authors.initials: JL
authors.lastname: Palmer
authors.forename: Loren
authors.initials: L
authors.lastname: Shen
authors.forename: Guddi
authors.initials: G
authors.lastname: Kaur
authors.forename: Jie
authors.initials: J
authors.lastname: Willey
authors.forename: Tao
authors.initials: T
authors.lastname: Zhang
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003125:Colostomy; D005242:Fecal Incontinence / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007297:Inpatients; D007902:Length of Stay; D008160:Lumbosacral Plexus / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D012004:Rectal Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery*; D013126:Spinal Nerve Roots / Q000503:physiopathology; D013524:Surgical Flaps; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology*; D016138:Walking; D014945:Wound Healing