Sacral Resection With Pelvic Exenteration for Advanced Primary and Recurrent Pelvic Cancer: A Single-Institution Experience of 100 Sacrectomies

• Published in: Diseases of the colon & rectum Vol. 57; no. 10; pp. 1153 - 1161
• Main Authors: Milne, Tony, Solomon, Michael J, Lee, Peter, Young, Jane M, Stalley, Paul, Harrison, James D, Austin, Kirk K S
• Format: Journal Article
• Language: English
• Published: United States The American Society of Colon and Rectal Surgeons 01.10.2014
• Subjects: Adenocarcinoma - secondary; Adenocarcinoma - surgery; Adult; Aged; Anastomotic Leak - etiology; Anus Neoplasms - pathology; Anus Neoplasms - surgery; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - surgery; Disease-Free Survival; Female; Follow-Up Studies; Humans; Ileus - etiology; Male; Middle Aged; Neoplasm Recurrence, Local - surgery; Pelvic Exenteration - adverse effects; Peripheral Nerve Injuries - etiology; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Retrospective Studies; Sacrum - pathology; Sacrum - surgery; Surgical Wound Infection - etiology; Survival Rate; Urinary Incontinence - etiology; Urinary Retention - etiology; Urinary Tract Infections - etiology
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1097/DCR.0000000000000196

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. DESIGN:This study used patient demographics, operative and pathologic reports, and prospective survival data to determine factors affecting patient outcomes. SETTINGS:Data were collected for patients who had operations between July 1998 and April 2012 at Royal Prince Alfred Hospital. PATIENTS: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. MAIN OUTCOME MEASURES: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. LIMITATIONS: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.