Sacropelvic resection for recurrent anorectal cancer - A multidisciplinaryapproach

A multimodal approach including preoperative external beam radiation, surgi cal resection, and intraoperative electron radiation was used in 23 patient s with locally advanced anal or recurrent rectal cancers involving the sacr um, The proximal extent of complete sacral resection was S2 in three patien ts, S3 in 12 patients, 54 in two patients, and S5 in one patient. The tumor was confined to the anterior sacral cortex in five patients. The resection was marginal in id, contaminated marginal in 11, and intralesional in two patients. At 19 to 54 months of followup, five patients are alive without e vidence of disease and four are alive with disease. Twelve patients died of their disease, and two died of other causes. There was a mean survival of 32.9 months for the patients who were alive at followup, Kaplan-Meier survi val for all patients was 82% at 1 year and 73% at 2 years, with death of di sease as an endpoint, Thirteen (57%) patients had another local recurrence develop at a mean of 17.2 months. Eight (35%) patients had metastatic disea se develop at a mean of 16.3 months, Proper patient selection is important in ensuring a favorable outcome from this aggressive surgery.