Abdominosacral resection of recurrent rectal cancer in the sacrum

PURPOSE: Resection of the sacrum is the only curative therapy of isolated s acral recurrence after primarily resected rectal cancer. The aim of the stu dy was to assess whether there is a benefit in terms of overall survival, m orbidity, and mortality when sacrum resection is per formed more radically and in cooperation between colorectal and orthopedic surgeons. Possible pro gnostic factors were also assessed. METHODS: Twelve consecutive patients wh o underwent interdisciplinary partial sacral resection were included in a r etrospective cohort study. Furthermore, overall survival rate and survival time were calculated. RESULTS: Histologic examination showed tumor-free res ection margins in all cases. Extended resection was necessary in seven pati ents, including total pelvic exenteration in two. No perioperative death oc curred and no patient required early reoperation. Complications were observ ed in 42 percent of patients, mainly caused by poor wound healing. All pati ents experienced relief from pain. One-year and three-year overall survival rates were 50 and 17 percent, respectively. The overall mean survival time was 21.7 months. Patients who died of recurrent disease within one year ei ther underwent former resection for locoregional recurrence, had extensive local recurrent tumors affecting pelvic visceral structures, or retrospecti vely suffered from metastatic sacral tumor manifestation. CONCLUSION: The m ortality and morbidity rates observed in the present study seem to justify partial sacral resection as a means to achieve palliation of perineosacral pain in spite of rare overall long-term survival.