title: Posterior high sacral segmental disconnection prior to anterior en bloc exenteration for recurrent rectal cancer.
abstract: This article describes a novel technique for en bloc resection of locally recurrent rectal cancer that invades the high sacral bone (above S3). The involved segment of the sacrum is mobilised with osteotomes during an initial posterior approach before an anterior abdominal phase where the segment of sacral bone is delivered with the specimen. This allows en bloc resection of the involved sacrum while preserving uninvolved distal and contralateral sacral bone and nerve roots. The goal is to obtain a clear bony margin and offer a chance of cure while improving functional outcomes by maintaining pelvic stability and minimising neurological deficit.
authors.affiliation: Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, Australia.|The Institute of Academic Surgery at RPA, Sydney Local Health District, Sydney, Australia.
authors.forename: K G M
authors.initials: KGM
authors.lastname: Brown
authors.affiliation: Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, Australia. professor.solomon@sydney.edu.au.|The Institute of Academic Surgery at RPA, Sydney Local Health District, Sydney, Australia. professor.solomon@sydney.edu.au.|Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia. professor.solomon@sydney.edu.au.|University of Sydney, Sydney, NSW, Australia. professor.solomon@sydney.edu.au.
authors.forename: M J
authors.initials: MJ
authors.lastname: Solomon
authors.affiliation: Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, Australia.|Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: K K S
authors.initials: KKS
authors.lastname: Austin
authors.affiliation: Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, Australia.|Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: P J
authors.initials: PJ
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Stalley
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D010385:Pelvic Exenteration / Q000379:methods*; D012004:Rectal Neoplasms / Q000601:surgery*; D012447:Sacrum / Q000601:surgery*; D016896:Treatment Outcome
keywords: Pelvic exenteration; Recurrent rectal cancer; Sacrectomy