title: Abdominal sacral resection for posterior pelvic recurrence of rectal carcinoma: analyses of prognostic factors and recurrence patterns.
abstract: BACKGROUND
  Local recurrence of rectal cancer presents challenging problems. Although abdominal sacral resection (ASR) provides pain control, survival prolongation, and possibly cure, reported morbidity and mortality are still high, and survival is still low. Thus, appropriate patient selection and adjuvant therapy based on prognostic factors and recurrence patterns are necessary. The purpose of this study was to evaluate the results of ASR for posterior pelvic recurrence of rectal carcinoma and to analyze prognostic factors and recurrence patterns.
  
  
  METHODS
  Forty-four patients underwent ASR for curative intent in 40 and palliative intent in 4 cases. All but one could be followed up completely. Multivariate analyses of factors influencing survival and positive surgical margins were conducted.
  
  
  RESULTS
  Morbidity and mortality were 61% and 2%, respectively. Overall 5-year survival was 34%. The Cox regression model revealed a positive resection margin (hazard ratio, 10 [95% confidence interval, 3.8-28]), a local disease-free interval of <12 months (4.2 [1.8-9.8]), and pain radiating to the buttock or further (4.2 [1.6-11]) to be independently associated with poor survival. The logistic regression model showed that macroscopic multiple expanding or diffuse infiltrating growths were independently associated with a positive margin (7.5 [1.4-40]). Of the patients with recurrence, 56% had failures confined locally or to the lung.
  
  
  CONCLUSIONS
  ASR is beneficial to selected patients in terms of survival. To select patients, evaluation of the resection margin, the local disease-free interval, pain extent, and macroscopic growth pattern is important. To improve survival, adjuvant treatment should be aimed at local and lung recurrences.
authors.affiliation: Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. takasu@ncc.go.jp
authors.forename: Takayuki
authors.initials: T
authors.lastname: Akasu
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Seiji
authors.initials: S
authors.lastname: Ishiguro
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Shin
authors.initials: S
authors.lastname: Fujita
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Moriya
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010385:Pelvic Exenteration; D010386:Pelvic Neoplasms / Q000556:secondary* / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology*; D012447:Sacrum / Q000601:surgery*; D013125:Spinal Neoplasms / Q000556:secondary* / Q000601:surgery*; D015996:Survival Rate