title: Sacral resection with pelvic exenteration for advanced primary and recurrent pelvic cancer: a single-institution experience of 100 sacrectomies.
abstract: BACKGROUND
  Recurrent and advanced primary pelvic cancers present a complex clinical issue requiring multidisciplinary care and radical extended surgery. Sacral resection is necessary for tumors that invade posteriorly but is associated with increased morbidity and mortality.
  
  
  OBJECTIVE
  This study aimed to analyze the morbidity and survival associated with pelvic exenteration involving sacrectomy for advanced pelvic cancers at a single institution.
  
  
  METHODS
  This study used patient demographics, operative and pathologic reports, and prospective survival data to determine factors affecting patient outcomes.
  
  
  METHODS
  Data were collected for patients who had operations between July 1998 and April 2012 at Royal Prince Alfred Hospital.
  
  
  METHODS
  One hundred patients underwent pelvic exenteration with a sacrectomy for advanced pelvic cancers. Sacrectomy was performed for 18 primary and 61 recurrent rectal cancers, 17 anal cancers, and 4 other cancers.
  
  
  METHODS
  This study looked at postoperative major and minor morbidity rates, as well as disease-free and overall survival rates after sacral resection. It compared the outcomes of high sacrectomy (at or above S2) versus low sacrectomy.
  
  
  RESULTS
  Clear margins were achieved in 72 of 100 patients. The overall complication rate was 74% (43% major and 67% minor) with no 30-day or in-hospital mortality. Estimated overall and disease-free survival rates after curative resection were 38% and 30% at 5 years. Involved margins (p = 0.006), lymph node involvement (p = 0.008), and anterior organ invasion (p = 0.008) had a negative impact on patient survival. High sacrectomy increased the incidence of neurologic deficit postoperatively (p = 0.04) but did not alter the rate of R0 resection or patient survival.
  
  
  CONCLUSIONS
  Retrospective data were required to analyze patient morbidity, as well as operative and pathologic factors.
  
  
  CONCLUSIONS
  This series supports sacral resection for curative surgery in advanced pelvic cancers, achieving excellent R0 and long-term survival rates. Cortical bone invasion and high sacrectomy were not contraindications to surgery and had acceptable outcomes.
authors.affiliation: 1Surgical Outcomes Research Centre, Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia 2Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia 3Discipline of Surgery, University of Sydney, Sydney, New South Wales, Australia 4Cancer Epidemiology and Services Research, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia 5Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Tony
authors.initials: T
authors.lastname: Milne
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Solomon
authors.forename: Peter
authors.initials: P
authors.lastname: Lee
authors.forename: Jane M
authors.initials: JM
authors.lastname: Young
authors.forename: Paul
authors.initials: P
authors.lastname: Stalley
authors.forename: James D
authors.initials: JD
authors.lastname: Harrison
authors.forename: Kirk K S
authors.initials: KK
authors.lastname: Austin
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D001005:Anus Neoplasms / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D045823:Ileus / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010385:Pelvic Exenteration / Q000009:adverse effects; D059348:Peripheral Nerve Injuries / Q000209:etiology; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012447:Sacrum / Q000473:pathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000209:etiology; D015996:Survival Rate; D014549:Urinary Incontinence / Q000209:etiology; D016055:Urinary Retention / Q000209:etiology; D014552:Urinary Tract Infections / Q000209:etiology