title: Abdominosacral resection for locally recurring rectal cancer.
abstract: OBJECTIVE
  To investigate feasibility and outcome of abdominal-sacral resection for treatment of locally recurrent rectal adenocarcinoma.
  
  
  METHODS
  A population of patients who underwent an abdominal-sacral resection for posterior recurrent adenocarcinoma of the rectum at the National Cancer Institute of Milano, between 2005 and 2013, is considered. Retrospectively collected data includes patient characteristics, treatment and pathology details regarding the primary and the recurrent rectal tumor surgical resection. A clinical and instrumental follow-up was performed. Surgical and oncological outcome were investigated. Furthermore an analytical review of literature was conducted in order to compare our case series with other reported experiences.
  
  
  RESULTS
  At the time of abdomino-sacral resection, the mean age of patients was 55 (range, 38-64). The median operating time was 380 min (range, 270-480). Sacral resection was performed at S2/S3 level in 3 patients, S3/S4 in 3 patients and S4/S5 in 4 patients. The median operating time was 380 ± 58 min. Mean intraoperative blood loss was 1750 mL (range, 200-680). The median hospital stay was 22 d. Overall morbidity was 80%, mainly type II complication according to the Clavien-Dindo classification. Microscopically negative margins (R0) is obtained in all patients. Overall 5-year survival after first surgical procedure is 60%, with a median survival from the first surgery of 88 ± 56 mo. The most common site of re-recurrence was intrapelvic.
  
  
  CONCLUSIONS
  Sacral resection represents a feasible approach to posterior rectal cancer recurrence without evidence of distant spreading. An accurate staging is essential for planning the best therapy.
authors.affiliation: Filiberto Belli, Carlo Corbellini, Ermanno Leo, Colorectal Surgery Unit, National Cancer Institute, 20133 Milan, Italy.
authors.forename: Filiberto
authors.initials: F
authors.lastname: Belli
authors.affiliation: Filiberto Belli, Carlo Corbellini, Ermanno Leo, Colorectal Surgery Unit, National Cancer Institute, 20133 Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gronchi
authors.affiliation: Filiberto Belli, Carlo Corbellini, Ermanno Leo, Colorectal Surgery Unit, National Cancer Institute, 20133 Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Corbellini
authors.affiliation: Filiberto Belli, Carlo Corbellini, Ermanno Leo, Colorectal Surgery Unit, National Cancer Institute, 20133 Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Milione
authors.affiliation: Filiberto Belli, Carlo Corbellini, Ermanno Leo, Colorectal Surgery Unit, National Cancer Institute, 20133 Milan, Italy.
authors.forename: Ermanno
authors.initials: E
authors.lastname: Leo
keywords: Abdominosacral resection; Local recurrence; Rectal cancer recurrence; Recurrent rectal cancer; Sacral resection