High sacrectomy for locally recurrent rectal cancer: Can long‐term survival be achieved?

Dozois, Eric J.; Privitera, A; Holubar, Stefan D.; Aldrete, J.F.; Sim, Franklin H.; Rose, Peter S.; Walsh, Michael F.; Bower, Thomas C.; Leibovich, B. C.; Larson, David W.

doi:10.1002/jso.21774

Cited by 87 publications

(54 citation statements)

References 38 publications

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“…After screening, 16 studies were found to be eligible for inclusion (1 prospective cohort study on radiosurgery (level II) [32]; 2 case series (level III) [28,33]; 4 retrospective case series (level IV) [2,10,34,35] and 9 case reports (level IV) [36][37][38][39][40][41][42][43][44]; Table 1). …”

Section: Resultsmentioning

confidence: 99%

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Management of metastatic sacral tumours

et al. 2012

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Purpose Metastatic involvement of the sacrum is rare and there is a paucity of studies which deal with the management of these tumours since most papers refer to primary sacral tumours. This study aims to review the available literature in the management of sacral metastatic tumours as reflected in the current literature. Methods A systematic review of the English language literature was undertaken for relevant articles published over the last 11 years (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). The PubMed electronic database and reference lists of key articles were searched to identify relevant studies using the terms ''sacral metastases'' and ''metastatic sacral tumours''. Studies involving primary sacral tumours only were excluded. For the assessment of the level of evidence quality, the CEBM (Oxford Centre of Evidence Based Medicine) grading system was utilised. Results The initial search revealed 479 articles. After screening, 16 articles identified meeting our inclusion criteria [1 prospective cohort study on radiosurgery (level II); 2 case series (level III); 4 retrospective case series (level IV) and 9 case reports (level IV)]. Conclusion The mainstay of management for sacral metastatic tumours is palliation. Preoperative angioembolisation is shown to be of value in cases of highly vascularised tumours. Radiotherapy is used as the primary treatment in cases of inoperable tumours without spinal instability where pain relief and neurological improvement are attainable. Minimal invasive procedures such as sacroplasties were shown to offer immediate pain relief and improvement with ambulation, whereas more aggressive surgery, involving decompression and sacral reconstruction, is utilised mainly for the treatment of local advanced tumours which compromise the stability of the spine or threaten neurological status. Adjuvant cryosurgery and radiosurgery have demonstrated promising results (if no neurological compromise or instability) with local disease control.

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Section: Resultsmentioning

confidence: 99%

“…Six studies report on their results of surgery ranging from posterior decompression with(out) cementation and instrumentation [2,28,35,43] to abdominal sacral resection [33] and en bloc sacrectomy [34,44].…”

Section: Treatmentmentioning

confidence: 99%

Management of metastatic sacral tumours

et al. 2012

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“…32 Long-term survival may be feasible in select patients with recurrent metastatic rectal cancer if margin-negative resection is achieved. 12,36 Furthermore, giant cell tumors, 19 primary sacral osteosarcomas, 34 and sacral chordomas 14 have been shown to be amenable to sacral resection, with reports of prolonged survival and functional recovery.…”

Section: Combined Vram and Free Fibular Flapsmentioning

confidence: 99%

Soft-tissue reconstruction after total en bloc sacrectomy

Kim

Pang²,

Christensen³

et al. 2015

SPI

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OBJECT Total en bloc sacrectomy is a dramatic procedure that results in extensive sacral defects. The authors present a series of patients who underwent flap reconstruction after total sacrectomy, report clinical outcomes, and provide a treatment algorithm to guide surgical care of this unique patient population. METHODS After institutional review board approval, data were collected for all patients who underwent total sacrectomy between 2002 and 2012 at The Johns Hopkins Hospital. Variables included demographic data, medical history, tumor characteristics, surgical details, postoperative complications, and clinical outcomes. All subtotal sacrectomies were excluded. RESULTS Between 2002 and 2012, 9 patients underwent total sacrectomy with flap reconstruction. Diagnoses included chordoma (n = 5), osteoblastoma (n = 1), sarcoma (n = 2), and metastatic colon cancer (n = 1). Six patients received gluteus maximus (GM) flaps with a prosthetic rectal sling following a single-stage, posterior sacrectomy. Four required additional paraspinous muscle (PSM) or pedicled latissimus dorsi (LD) fasciocutaneous flaps. Three patients underwent multistage sacrectomy with an anterior-posterior approach, 2 of whom received pedicled vertical rectus abdominis myocutaneous (VRAM) flaps, and 1 of whom received local GM, LD, and PSM flaps. Flap complications included dehiscence (n = 4) and infection (n = 1). During the 1st year of follow-up, 2 of 9 patients (22%) were able to ambulate with an assistive device by the 1st postoperative month, and 6 of 9 (67%) were ambulatory with a walker by the 3rd postoperative month. By postoperative Month 12, 5 of 9 patients (56%)—or 5 of 5 patients not lost to follow-up (100%)—were able to able to ambulate independently. CONCLUSIONS The authors' experience suggests that the GM and pedicled VRAM flaps are reliable options for softtissue reconstruction of total sacrectomy defects. For posterior-only operations, GM flaps with or without a prosthetic rectal sling are generally used. For multistage operations including a laparotomy, the authors consider the pedicled VRAM flap to be the gold standard for simultaneous reconstruction of the pelvic diaphragm and obliteration of dead space.

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“…Правда, авторы подобных публикаций не ссылаются на контролируемые рандомизированные исследования и не проводят какой-либо статистической оценки рисков осложнений. Дру-гие исследователи считают такие операции допустимы-ми, указывая в качестве аргумента собственный опыт их выполнения [11].…”

Section: However the Choice Of Tactics For This Patient Category Remunclassified