Composite abdominosacral resection for recurrent rectal cancer.
BACKGROUND
En bloc resection of the tumour and adjacent involved organs offers the only realistic curative option for patients with locally recurrent rectal cancer. This study assessed outcomes of composite resection for recurrent tumours involving the sacrum.


METHODS
A consecutive series of patients underwent composite abdominosacral resection (abdominal mobilization and stoma construction followed by sacral division and tumour retrieval) for recurrent rectal cancer between 2001 and 2007. Patients were staged with preoperative computed tomography, magnetic resonance imaging and positron emission tomography. Data were collected prospectively.


RESULTS
Forty patients (28 men; median age 59 (range 31-77) years) underwent surgery with sacral division at the S2/3 interface in 13, S3/4 level in 20 and S4/5 level in seven patients. One patient died and 24 had complications. An R0 resection was achieved in 20 patients and conferred benefit in disease-free interval over an R1 resection. The mean disease-free interval was 55.6 (95 per cent confidence interval (c.i.) 40.0 to 71.3) months for R0 and 32.2 (95 per cent c.i. 19.7 to 44.7) months for R1 resection (P = 0.048).


CONCLUSIONS
Composite abdominosacral resection of locally recurrent rectal cancer is an effective treatment for a difficult clinical scenario.
Sagar
P M
PM
Department of Colon and Rectal Surgery, General Infirmary at Leeds, Leeds, UK. petersagar@aol.com
Gonsalves
S
S
Heath
R M
RM
Phillips
N
N
Chalmers
A G
AG
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012447:Sacrum / Q000601:surgery*; D016896:Treatment Outcome