Assessing the impact of a sacral resection on morbidity and survival after extended radical surgery for locally recurrent rectal cancer.
OBJECTIVE
To describe the experience of sacrectomy with extended radical resection in the treatment of locally recurrent rectal cancer.


BACKGROUND
Resections of the bony pelvis, especially the sacrum, are becoming more common as part of extended radical exenterations for patients with recurrent rectal cancer. However, sacrectomy has been shown to carry a significant decrease in survival. Morbidity rates have been associated with the level of the sacrectomy (ie, >S3 junction).


METHODS
An analysis was conducted using prospective data from patients with recurrent rectal cancer who underwent pelvic exenteration involving sacrectomy from July 1998 until June 2011. The impact of the proximal level of sacrectomy [low (≤S3) vs high (≥S2-S3 disc)] was compared.


RESULTS
Of 240 exenteration patients, 79 underwent sacrectomy, with 49 for recurrent rectal cancer. An R0 margin was achieved in 36 (74%) patients. Achievement of clear operative margins (R0) conferred a large and significant benefit for disease-free survival compared with R1 and R2 resections (median 45 months vs 19 and 8 months, respectively; P = 0.045). Complications were reported in 40 (82%) patients, with major and minor complications in 19 (39%) and 38 (78%) patients, respectively. The proximal level of the sacrectomy (high vs low) did not significantly impair the ability to achieve a clear margin and was not associated with an increase in major or minor complications.


CONCLUSIONS
This large, single-center series has demonstrated that extended pelvic exenteration involving sacrectomy has excellent R0 margins and survival rates for recurrent rectal cancer. A high sacrectomy has comparable results with a more distal abdominosacral resection.
*Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney †Department of Colorectal Surgery, Royal Prince Alfred Hospital ‡Discipline of Surgery, University of Sydney §Cancer Epidemiology and Services Research, Sydney School of Public Health, University of Sydney ¶Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Tony
T
Milne
Michael J
MJ
Solomon
Peter
P
Lee
Jane M
JM
Young
Paul
P
Stalley
James D
JD
Harrison
D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010385:Pelvic Exenteration; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012447:Sacrum / Q000601:surgery*; D015996:Survival Rate