Composite sacropelvic resection for locally advanced recurrent rectal cancer is a high-risk procedure that benefits select patients.
Dr Genevieve Melton and colleagues from New York reviewed a recent institutional experience to evaluate case selection, morbidity, and outcomes for these patients.
Between 1987 and 2004, 29 patients underwent composite resection for recurrent locoregional rectal cancer.
The research team evaluated clinicopathologic indicators as indicators of survival by log-rank test and Cox proportional hazards model.
The researchers reported that 10 patients received radiotherapy with their previous surgery, 17 before sacrectomy, and 12 received intraoperative therapy.
Sacral resections were performed at S2/S3 or S4/S5 using anterior or combined anterior-posterior approach, with adherence to or cortical invasion in the sacrum.
The researchers found the majority of those who had undergone previous abdominoperineal resection had total exenteration.
Most patients who had undergone a previous sphincter-preserving procedure had abdominoperineal resection and none had exenteration.
The team noted that pedicle flaps were used often.
A median of 5 units of blood was given intraoperatively.
| The 2-year recurrence rate was 47%|
|Diseases of the Colon & Rectum|
The researchers observed that transfusions were associated with previous abdominoperineal resection, correlating strongly with postoperative morbidity.
There were 33 complications in 17 patients, most commonly perineal wound breakdown in 9, and pelvic abscess in 5.
Median hospital stay was 18 days, significantly longer in patients with previous abdominoperineal resection or postoperative morbidity.
The team noted that only postoperative death was from pelvic sepsis.
Resection was complete in 18 patients, with microscopically positive margins in 10, and grossly positive margins in 1.
The researchers identified that the 2-year and 5-year recurrence rates were 47% and 85%, respectively.
Disease-specific survival was 63% and 20%, at 2- and 5 years, respectively.
The team found that less transfusion, complete resection, lack of anterior organ involvement, and absence of cortical bone invasion were associated with better survival on univariate analysis.
Original colorectal cancer stage was not associated with improved survival.
Dr Melton's team commented, “Sacrectomy for rectal cancer is a high-risk procedure that can achieve clear resection margins with low mortality in select patients.”
“This procedure has a low cure rate but may provide local disease control with acceptable morbidity.”