Sacral Resection With Pelvic Exenteration for Advanced Primary and Recurrent Pelvic Cancer

Milne, Tony; Solomon, Michael J.; Lee, Peter; Young, Jane; Stalley, Paul; Harrison, James D.; Austin, Kirk K. S.

doi:10.1097/dcr.0000000000000196

Cited by 58 publications

(48 citation statements)

References 28 publications

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“…Not only was positive resection margin a significant predictor of mortality, the present study showed overall survival was significantly poorer at 5 years after R1 or R2 resection. This is in keeping with previous findings. There was no significant difference in R0 resection rates between high versus low sacral resection.…”

Section: Discussionsupporting

confidence: 92%

“…By using ultraradical exenterative techniques, long‐term survival can now be achieved in up to 60 per cent of patients with locally advanced and recurrent disease. Initially, involvement of the sacrum was considered a contraindication to curative exenteration; however, en bloc sacral excision to ensure clear resection margins is now performed routinely at specialist centres, with acceptable morbidity, oncological and functional outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Influence of the level of sacrectomy on survival in patients with locally advanced and recurrent rectal cancer

Lau

Jongerius

Wakeman

et al. 2019

British Journal of Surgery

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Background: Exenterative surgery for locally advanced rectal cancer may involve partial sacrectomy to achieve complete resection. High sacrectomy is technically challenging, and can be associated with high morbidity and mortality rates. The aim of this study was to determine the influence of the level of sacrectomy on the survival of patients with locally advanced rectal cancer.Methods: This was an international multicentre retrospective analysis of patients undergoing exenterative abdominosacrectomy between July 2006 and June 2016. High sacrectomy was defined as resection at or above the junction of S2-S3; low sacrectomy was below the S2-S3 junction. Kaplan-Meier survival analysis was used to assess overall survival and cancer-specific survival. Predictive factors were determined using Cox regression analysis.Results: A total of 345 patients were identified, of whom 91 underwent high sacrectomy and 254 low sacrectomy. There was no difference in 5-year overall survival (53 versus 44⋅1 per cent; P = 0⋅216) or cancer-specific survival (60 versus 56⋅1 per cent; P = 0⋅526) between high and low sacrectomy. Negative margin rates were similar for primary and recurrent disease: 65 of 90 (72 per cent) versus 97 of 153 (63⋅4 per cent) (P = 0⋅143). Level of sacrectomy was not a significant predictor of mortality (P = 0⋅053). Positive resection margin and advancing age were the only significant predictors for death, with hazard ratios of 2⋅78 (P < 0⋅001) and 1⋅02 (P = 0⋅020) respectively. Conclusion: There was no survival difference between patients who underwent high or low sacrectomy. In appropriately selected patients, high sacrectomy is feasible and safe.Answer: This patient's bladder was perforated during insertion of a suprapubic port. A Pfannensteil incision was made and the bladder was found to be perforated at the dome, where the drain had been inserted. The perforation was repaired in two layers. The urinary catheter was left in situ for a month, after which the patient made an uneventful recovery. The incidence of bladder injury secondary to instrumentation in laparoscopic surgery is 0•3-0•5 per cent. Management may be either conservative with insertion of an indwelling catheter, or surgical repair by a laparoscopic or open method. This serves as a reminder that surgeons should exercise caution during insertion of a suprapubic port. Air in the urinary catheter bag is suggestive of bladder perforation.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Influence of the level of sacrectomy on survival in patients with locally advanced and recurrent rectal cancer

Lau

Jongerius

Wakeman

et al. 2019

British Journal of Surgery

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“…Whether radical exenterative surgery is a treatment option partly depends on the level of sacral involvement. In most institutions, invasion above the S2-S3 junction is a relative contraindication to resection, although high sacrectomy is also practiced in some centers [92].…”

Section: Locoregional Recurrencementioning

confidence: 99%

MRI of Rectal Cancer: An Overview and Update on Recent Advances

Jhaveri

Hosseini-Nik

2015

American Journal of Roentgenology

141

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“…С 1998 по 2012 г. они провели 79 подобных опе-раций. Согласно опубликованным данным, R0-резек-ция была достигнута в 72 % случаев [15]. Частота послеоперационных осложнений составила 74 %, об-щая 5-летняя выживаемость -38 %, безрецидивная -30 %, послеоперационной летальности не отмечено.…”

Section: анализ опубликованных исследованийunclassified

Abdominosacral resection in the surgical treatment of rectal cancer

Карачун¹,

Gafton²,

Самсонов³

et al. 2015

Onkol. koloproktol.

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Sacral Resection With Pelvic Exenteration for Advanced Primary and Recurrent Pelvic Cancer

Abstract: This series supports sacral resection for curative surgery in advanced pelvic cancers, achieving excellent R0 and long-term survival rates. Cortical bone invasion and high sacrectomy were not contraindications to surgery and had acceptable outcomes.

Cited by 58 publications

References 28 publications

Influence of the level of sacrectomy on survival in patients with locally advanced and recurrent rectal cancer

Influence of the level of sacrectomy on survival in patients with locally advanced and recurrent rectal cancer

MRI of Rectal Cancer: An Overview and Update on Recent Advances

Abdominosacral resection in the surgical treatment of rectal cancer

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