Abdominosacral resection for locally advanced and recurrent rectal cancer.

Abstract

The results of resection of locally advanced and recurrent rectal cancers, including sacral resection, were analysed critically. Between 1987 and 2007, 353 patients with locally advanced or recurrent rectal cancer, all treated in a tertiary referral centre, were identified from a prospective database. Twenty-five patients (eight primary and 17 recurrent tumours) underwent en bloc sacral resection. A mid-sacral resection was carried out in 12 patients (level S3) and a low sacral resection in 13 (level S4/S5). Nineteen patients had an R0, four an R1 and two an R2 resection. There was no postoperative mortality. Median follow-up was 32 months. Incomplete resection had an independent negative influence on local control (5-year local recurrence rate 42 versus 0 per cent in those with and without incomplete resection; P < 0.001). The 5-year overall survival rate was 30 per cent. Five patients with recurrent tumour had pathological invasion into the sacral bone and none survived beyond 1 year. Abdominosacral resection can be performed in patients with locally advanced and recurrent rectal cancer. Patients who cannot undergo a complete resection or have clear evidence of cortical invasion have a poor prognosis.