Skip to main content
SpringerLink
Log in

Sacral Resection for Recurrent Rectal Cancer: Analysis of Morbidity and Treatment Results

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Purpose

Composite sacropelvic resection for locally advanced recurrent rectal cancer is a high-risk procedure that benefits select patients. We reviewed our recent institutional experience to evaluate case selection, morbidity, and outcomes.

Methods

Between 1987 and 2004, 29 patients underwent composite resection for recurrent locoregional rectal cancer (17 females; median age, 60 years). Clinicopathologic indicators were evaluated as indicators of survival by log-rank test and Cox proportional hazards model.

Results

Of 29 total patients, 27 (93 percent) received radiotherapy with their previous surgery (n = 10; 34 percent) or before sacrectomy (n = 17; 59 percent), and 12 (41 percent) received intraoperative therapy. Sacral resections were performed at S2/S3 (55 percent) or S4/S5 (45 percent) using anterior (41 percent) or combined anterior-posterior approach (59 percent), with adherence to (62 percent) or cortical invasion in (38 percent) the sacrum. A majority of those who had undergone previous abdominoperineal resection had total exenteration (9/13), whereas most patients who had undergone a previous sphincter-preserving procedure had abdominoperineal resection (12/16) and none had exenteration. Pedicle flaps (omental, 11; abdominal rectus, 7) often were used. A median of five (range, 1–33) units of blood was given intraoperatively. Transfusions were associated with previous abdominoperineal resection (P < 0.03), correlating strongly with postoperative morbidity (P < 0.02). There were 33 complications in 17 (59 percent) patients, most commonly perineal wound breakdown (9 (31 percent)) and pelvic abscess (5 (17 percent)). Median hospital stay was 18 (range, 7–56) days, significantly longer in patients with previous abdominoperineal resection (P < 0.02) or postoperative morbidity (P < 0.03). The only postoperative death was from pelvic sepsis. Resection was complete (R0) in 18 patients (62 percent), with microscopically positive margins (R1) in 10 (34 percent) and grossly positive margins (R2) in 1 (3 percent). Two-year and five-year recurrence rates were 47 and 85 percent, respectively; disease-specific survival was 63 and 20 percent, respectively. Less transfusion (P = 0.03), R0 resection (P = 0.005), lack of anterior organ involvement (P = 0.02), and absence of cortical bone invasion (P < 0.001) were associated with better survival on univariate analysis; original colorectal cancer stage was not.

Conclusions

Sacrectomy for rectal cancer is a high-risk procedure that can achieve clear resection margins with low mortality in select patients. This procedure has a low cure rate but may provide local disease control with acceptable morbidity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. H Martijn W Neve Particlede ML Lybeert MA Crommelin JG Ribot (1995) ArticleTitleAdjuvant postoperative radiotherapy for adenocarcinoma of the rectum and rectosigmoid. A retrospective analysis of locoregional control, survival, and prognostic factors on 178 patients Am J Clin Oncol 18 277–281 Occurrence Handle7625365 Occurrence Handle1:STN:280:ByqA2M7ivVw%3D

    PubMed  CAS  Google Scholar 

  2. CS Wong BJ Cummings JD Brierley et al. (1998) ArticleTitleTreatment of locally recurrent rectal carcinoma–results and prognostic factors Int J Radiat Oncol Biol Phys 40 427–435 Occurrence Handle9457832 Occurrence Handle1:STN:280:DyaK1c7hslSisg%3D%3D Occurrence Handle10.1016/S0360-3016(97)00737-2

    Article  PubMed  CAS  Google Scholar 

  3. OA Ogunbiyi K McKenna EH Birnbaum JW Fleshman IJ Kodner (1997) ArticleTitleAggressive surgical management of recurrent rectal cancer–is it worthwhile? Dis Colon Rectum 40 150–155 Occurrence Handle9075748 Occurrence Handle1:STN:280:ByiB3s%2FhslQ%3D Occurrence Handle10.1007/BF02054979

    Article  PubMed  CAS  Google Scholar 

  4. R Farouk H Nelson LL Gunderson (1997) ArticleTitleAggressive multimodality treatment for locally advanced irresectable rectal cancer Br J Surg 84 741–749 Occurrence Handle9189078 Occurrence Handle1:STN:280:ByiA3s3ptFI%3D Occurrence Handle10.1002/bjs.1800840604

    Article  PubMed  CAS  Google Scholar 

  5. SJ Pilipshen M Heilweil SH Quan SS Sternberg WE Enker (1984) ArticleTitlePatterns of pelvic recurrence following definitive resections of rectal cancer Cancer 53 1354–1362 Occurrence Handle6692324 Occurrence Handle1:STN:280:BiuC3cnjvVY%3D Occurrence Handle10.1002/1097-0142(19840315)53:6<1354::AID-CNCR2820530623>3.0.CO;2-J

    Article  PubMed  CAS  Google Scholar 

  6. JP Welch GA Donaldson (1978) ArticleTitleDetection and treatment of recurrent cancer of the colon and rectum Am J Surg 135 505–511 Occurrence Handle637196 Occurrence Handle1:STN:280:CSeC2c3ksFE%3D Occurrence Handle10.1016/0002-9610(78)90028-4

    Article  PubMed  CAS  Google Scholar 

  7. AR Rao AR Kagan PM Chan HA Gilbert H Nussbaum BL Hintz (1981) ArticleTitlePatterns of recurrence following curative resection alone for adenocarcinoma of the rectum and sigmoid colon Cancer 48 1492–1495 Occurrence Handle7272970 Occurrence Handle1:STN:280:Bi2D3c7ptFI%3D Occurrence Handle10.1002/1097-0142(19810915)48:6<1492::AID-CNCR2820480636>3.0.CO;2-K

    Article  PubMed  CAS  Google Scholar 

  8. LL Gunderson H Sosin (1974) ArticleTitleAreas of failure found at reoperation (second or symptomatic look) following “curative surgery” for adenocarcinoma of the rectum. Clinicopathologic correlation and implications for adjuvant therapy Cancer 34 1278–1292 Occurrence Handle4424091 Occurrence Handle1:STN:280:CSqD3s3nsVc%3D Occurrence Handle10.1002/1097-0142(197410)34:4<1278::AID-CNCR2820340440>3.0.CO;2-F

    Article  PubMed  CAS  Google Scholar 

  9. T Rich LL Gunderson R Lew JJ Galdibini AM Cohen G Donaldson (1983) ArticleTitlePatterns of recurrence of rectal cancer after potentially curative surgery Cancer 52 1317–1329 Occurrence Handle6192900 Occurrence Handle1:STN:280:BiyB1cvnvV0%3D Occurrence Handle10.1002/1097-0142(19831001)52:7<1317::AID-CNCR2820520731>3.0.CO;2-6

    Article  PubMed  CAS  Google Scholar 

  10. JC Salo PB Paty J Guillem BD Minsky LB Harrison AM Cohen (1999) ArticleTitleSurgical salvage of recurrent rectal carcinoma after curative resection: a 10-year experience Ann Surg Oncol 6 171–177 Occurrence Handle10082043 Occurrence Handle1:STN:280:DyaK1M7otVSrsg%3D%3D Occurrence Handle10.1007/s10434-999-0171-8

    Article  PubMed  CAS  Google Scholar 

  11. AM Cohen BD Minsky (1990) ArticleTitleAggressive surgical management of locally advanced primary and recurrent rectal cancer. Current status and future directions Dis Colon Rectum 33 432–438 Occurrence Handle2183979 Occurrence Handle1:STN:280:By%2BB38fhtV0%3D Occurrence Handle10.1007/BF02156274

    Article  PubMed  CAS  Google Scholar 

  12. WJ Temple AS Ketcham (1992) ArticleTitleSacral resection for control of pelvic tumors Am J Surg 163 370–374 Occurrence Handle1373043 Occurrence Handle1:STN:280:By2B3MvnsV0%3D Occurrence Handle10.1016/0002-9610(92)90035-P

    Article  PubMed  CAS  Google Scholar 

  13. HJ Wanebo P Antoniuk RJ Koness et al. (1999) ArticleTitlePelvic resection of recurrent rectal cancer: technical considerations and outcomes Dis Colon Rectum 42 1438–1448 Occurrence Handle10566532 Occurrence Handle10.1007/BF02235044

    Article  PubMed  Google Scholar 

  14. HJ Wanebo RJ Koness MP Vezeridis SI Cohen DE Wrobleski (1994) ArticleTitlePelvic resection of recurrent rectal cancer Ann Surg 220 586–595 Occurrence Handle7524455 Occurrence Handle1:STN:280:ByqD3s7jsFM%3D

    PubMed  CAS  Google Scholar 

  15. S Magrini H Nelson LL Gunderson FH Sim (1996) ArticleTitleSacropelvic resection and intraoperative electron irradiation in the management of recurrent anorectal cancer Dis Colon Rectum 39 1–9 Occurrence Handle8601342 Occurrence Handle1:STN:280:BymC1c7jt1I%3D Occurrence Handle10.1007/BF02048260

    Article  PubMed  CAS  Google Scholar 

  16. J Zacherl R Schiessel R Windhager et al. (1999) ArticleTitleAbdominosacral resection of recurrent rectal cancer in the sacrum Dis Colon Rectum 42 1035–1040 Occurrence Handle10458127 Occurrence Handle1:STN:280:DyaK1MzosFejuw%3D%3D Occurrence Handle10.1007/BF02236698

    Article  PubMed  CAS  Google Scholar 

  17. GH Mannaerts HJ Rutten H Martijn GJ Groen PE Hanssens T Wiggers (2001) ArticleTitleAbdominosacral resection for primary irresectable and locally recurrent rectal cancer Dis Colon Rectum 44 806–814 Occurrence Handle11391140 Occurrence Handle1:STN:280:DC%2BD3Mzkt1Cgug%3D%3D Occurrence Handle10.1007/BF02234699

    Article  PubMed  CAS  Google Scholar 

  18. K Yamada T Ishizawa K Niwa Y Chuman T Aikou (2002) ArticleTitlePelvic exenteration and sacral resection for locally advanced primary and recurrent rectal cancer Dis Colon Rectum 45 1078–1084 Occurrence Handle12195193 Occurrence Handle10.1007/s10350-004-6363-1

    Article  PubMed  Google Scholar 

  19. R Bakx JJ Lanschot Particlevan FA Zoetmulder (2004) ArticleTitleSacral resection in cancer surgery: surgical technique and experience in 26 procedures J Am Coll Surg 198 846–851 Occurrence Handle15110821 Occurrence Handle10.1016/j.jamcollsurg.2003.12.007

    Article  PubMed  Google Scholar 

  20. Y Moriya T Akasu S Fujita S Yamamoto (2004) ArticleTitleTotal pelvic exenteration with distal sacrectomy for fixed recurrent rectal cancer in the pelvis Dis Colon Rectum 47 2047–2054 Occurrence Handle15657653 Occurrence Handle10.1007/s10350-004-0714-9

    Article  PubMed  Google Scholar 

  21. InstitutionalAuthorNameAmerican Joint Committee on Cancer (2002) AJCC cancer staging manual EditionNumber6 Springer-Verlag New York

    Google Scholar 

  22. KM Alektiar MJ Zelefsky PB Paty et al. (2000) ArticleTitleHigh-dose-rate intraoperative brachytherapy for recurrent colorectal cancer Int J Radiat Oncol Biol Phys 48 219–226 Occurrence Handle10924992 Occurrence Handle1:STN:280:DC%2BD3czps1aksA%3D%3D Occurrence Handle10.1016/S0360-3016(00)00634-9

    Article  PubMed  CAS  Google Scholar 

  23. RC Martin SuffixII DP Jaques MF Brennan M Karpeh (2002) ArticleTitleAchieving RO resection for locally advanced gastric cancer: is it worth the risk of multiorgan resection? JAm Coll Surg 194 568–577 Occurrence Handle10.1016/S1072-7515(02)01116-X

    Article  Google Scholar 

  24. RC Martin SuffixII MF Brennan DP Jaques (2002) ArticleTitleQuality of complication reporting in the surgical literature Ann Surg 235 803–813 Occurrence Handle12035036 Occurrence Handle10.1097/00000658-200206000-00007

    Article  PubMed  Google Scholar 

  25. Weber KL, Nelson H, Gunderson LL, Sim FH. Sacropelvic resection for recurrent anorectal cancer. A multidisciplinary approach. Clin Orthop Relat Res 2000:231–40

  26. DB Chessin JG Guillem (2005) ArticleTitleRectus flap reconstruction decreases perineal wound complications after pelvic chemoradiation and surgery: a cohort study Ann Surg Oncol 12 104–110 Occurrence Handle15827789 Occurrence Handle10.1245/ASO.2005.03.100

    Article  PubMed  Google Scholar 

  27. SJ Loessin NB Meland RM Devine BG Wolff H Nelson H Zincke (1995) ArticleTitleManagement of sacral and perineal defects following abdominoperineal resection and radiation with transpelvic muscle flaps Dis Colon Rectum 38 940–945 Occurrence Handle7656741 Occurrence Handle1:STN:280:ByqA1crltlY%3D Occurrence Handle10.1007/BF02049729

    Article  PubMed  CAS  Google Scholar 

  28. RE Jimenez M Shoup AM Cohen PB Paty J Guillem WD Wong (2003) ArticleTitleContemporary outcomes of total pelvic exenteration in the treatment of colorectal cancer Dis Colon Rectum 46 1619–1625 Occurrence Handle14668586

    PubMed  Google Scholar 

  29. R Schiessel M Wunderlich F Herbst (1986) ArticleTitleLocal recurrence of colorectal cancer: effect of early detection and aggressive surgery Br J Surg 73 342–344 Occurrence Handle3708277 Occurrence Handle1:STN:280:BimB3MnpsV0%3D

    PubMed  CAS  Google Scholar 

  30. HC Polk SuffixJr JS Spratt SuffixJr (1979) ArticleTitleThe results of treatment of perineal recurrence of cancer of the rectum Cancer 43 952–955 Occurrence Handle427735 Occurrence Handle10.1002/1097-0142(197903)43:3<952::AID-CNCR2820430325>3.0.CO;2-#

    Article  PubMed  Google Scholar 

  31. AR Miller SB Cantor GE Peoples DB Pearlstone JM Skibber (2000) ArticleTitleQuality of life and cost effectiveness analysis of therapy for locally recurrent rectal cancer Dis Colon Rectum 43 1695–1701 Occurrence Handle11156453 Occurrence Handle1:STN:280:DC%2BD3M%2FpvFGqsw%3D%3D Occurrence Handle10.1007/BF02236852

    Article  PubMed  CAS  Google Scholar 

  32. NF Esnaola SB Cantor ML Johnson et al. (2002) ArticleTitlePain and quality of life after treatment in patients with locally recurrent rectal cancer J Clin Oncol 20 4361–4367 Occurrence Handle12409336 Occurrence Handle10.1200/JCO.2002.02.121

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Colorectal Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    Genevieve B. Melton M.D., Philip B. Paty M.D., Salvatore G. Savatta M.D., José G. Guillem M.D., Martin R. Weiser M.D., W. Douglas Wong M.D. & Larissa K. Temple M.D.

  2. Orthopedic Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    Patrick J. Boland M.D., John H. Healey M.D. & Jorge E. Casas-Ganem M.D.

  3. Department of Surgery, University of Kentucky, Lexington, Kentucky, USA

    Alfred M. Cohen M.D.

  4. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    Bruce D. Minsky M.D.

  5. Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York, 10021, USA

    Larissa K. Temple M.D.

Authors
  1. Genevieve B. Melton M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philip B. Paty M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patrick J. Boland M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John H. Healey M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Salvatore G. Savatta M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jorge E. Casas-Ganem M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. José G. Guillem M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Martin R. Weiser M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alfred M. Cohen M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Bruce D. Minsky M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. W. Douglas Wong M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Larissa K. Temple M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Reprints are not available.

About this article

Cite this article

Melton, G.B., Paty, P.B., Boland, P.J. et al. Sacral Resection for Recurrent Rectal Cancer: Analysis of Morbidity and Treatment Results. Dis Colon Rectum 49, 1099–1107 (2006). https://doi.org/10.1007/s10350-006-0563-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-006-0563-9

Key words

Search

Navigation