Published online Dec 27, 2016. doi: 10.4240/wjgs.v8.i12.770
Peer-review started: June 28, 2016
First decision: August 5, 2016
Revised: September 27, 2016
Accepted: October 22, 2016
Article in press: October 24, 2016
Published online: December 27, 2016
To investigate feasibility and outcome of abdominal-sacral resection for treatment of locally recurrent rectal adenocarcinoma.
A population of patients who underwent an abdominal-sacral resection for posterior recurrent adenocarcinoma of the rectum at the National Cancer Institute of Milano, between 2005 and 2013, is considered. Retrospectively collected data includes patient characteristics, treatment and pathology details regarding the primary and the recurrent rectal tumor surgical resection. A clinical and instrumental follow-up was performed. Surgical and oncological outcome were investigated. Furthermore an analytical review of literature was conducted in order to compare our case series with other reported experiences.
At the time of abdomino-sacral resection, the mean age of patients was 55 (range, 38-64). The median operating time was 380 min (range, 270-480). Sacral resection was performed at S2/S3 level in 3 patients, S3/S4 in 3 patients and S4/S5 in 4 patients. The median operating time was 380 ± 58 min. Mean intraoperative blood loss was 1750 mL (range, 200-680). The median hospital stay was 22 d. Overall morbidity was 80%, mainly type II complication according to the Clavien-Dindo classification. Microscopically negative margins (R0) is obtained in all patients. Overall 5-year survival after first surgical procedure is 60%, with a median survival from the first surgery of 88 ± 56 mo. The most common site of re-recurrence was intrapelvic.
Sacral resection represents a feasible approach to posterior rectal cancer recurrence without evidence of distant spreading. An accurate staging is essential for planning the best therapy.
Core tip: During the last years, great efforts have been invested by many authors to contribute in treatment of rectal cancer recurrence without evidence of distant spreading. The most difficult surgical problem is to perform an affective radical R0 salvage resection. However, with the introduction of sacral resection, consistent improvements have been achieved in recent years, particularly when local tumor relapse occurs in the posterior part of the pelvis, from the presacral to the retrovescical spaces. However, abdominosacral resection is a complex surgical procedure affected by several postoperative complications. For this reason, these patients should be treated into dedicated and specialized institutions.