title: Single-stage anterior high sacrectomy for locally recurrent rectal cancer.
abstract: METHODS
  A review of prospectively collected data on a consecutive series of patients undergoing single-stage anterior high sacrectomy for locally recurrent rectal carcinoma (LRRC).
  
  
  OBJECTIVE
  To determine the clinical outcome of patients who underwent anterior high sacrectomy for LRRC.
  
  
  BACKGROUND
  High sacrectomy for oncological resection remains technically challenging. Surgery has the potential to achieve cure in carefully selected patients. Complete (R0) tumor excision in LRRC may require sacrectomy. High sacral resections (S3 and above) typically require a combined anterior/supine and posterior/prone procedure. We investigated our experience performing single-stage anterior high sacrectomy for LRRC.
  
  
  METHODS
  A consecutive series of patients with LRRC without systemic metastases who underwent resection with curative intent requiring high sacrectomy were identified. A review of a prospectively maintained colorectal and spine cancer database data was performed. An oblique dome high sacral osteotomy was performed during a single-stage anterior procedure. Outcome measures included surgical resection margin status, hospital length of stay, postoperative complications, physical functioning status, and overall survival.
  
  
  RESULTS
  Nineteen consecutive patients were treated between 2002 and 2011. High sacrectomy was performed at sacral level S1-S2 in 4 patients, S2-S3 in 9 patients, and through S3 in 6 patients. An R0 resection margin was achieved histologically in all 19 cases. There was 1 early (<30 d) postoperative death (1/19, 5%). At median follow-up of 38 months, 13 patients had no evidence of residual disease, 1 was alive with disease, and 4 had died of disease. Morbidities occurred in 15 of the 19 patients (79%).
  
  
  CONCLUSIONS
  Although high sacrectomy may require a combined anterior and posterior surgical approach, our series demonstrates the feasibility of performing single-stage anterior high sacrectomy in LRRC, with acceptable risks and outcomes compared with the literature. The procedure described by us for LRRC lessens the need for a simultaneous or staged prone posterior resection, with favorable R0 tumor resections, patient survival, and clinical outcomes.
  
  
  METHODS
  N/A.
authors.affiliation: *Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Holland Musculoskeletal Program and Division of Orthopaedics, Department of Surgery, University of Toronto, and the Department of Surgery University of Toronto Spine Program, Toronto, Ontario, Canada; and †Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, and the Division of General Surgery, Department of Surgery, University of Toronto, Ontario, Canada.
authors.forename: Khaled
authors.initials: K
authors.lastname: Fawaz
authors.affiliation: *Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Holland Musculoskeletal Program and Division of Orthopaedics, Department of Surgery, University of Toronto, and the Department of Surgery University of Toronto Spine Program, Toronto, Ontario, Canada; and †Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, and the Division of General Surgery, Department of Surgery, University of Toronto, Ontario, Canada.
authors.forename: Fawaz
authors.initials: F
authors.lastname: Khaled
authors.forename: Myles J
authors.initials: MJ
authors.lastname: Smith
authors.forename: Cukier
authors.initials: C
authors.lastname: Moises
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Smith
authors.forename: Albert J M
authors.initials: AJ
authors.lastname: Yee
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009437:Neuralgia / Q000209:etiology; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014946:Wound Infection / Q000209:etiology