Towards Standardisation of Technique for En Bloc Sacrectomy for Locally Advanced and Recurrent Rectal Cancer

Rogers, Ailín C.; Jenkins, John T.; Malietzis, George; Burns, Elaine; Kontovounisios, Christos; Tekkis, Paris

doi:10.3390/jcm10214921

Cited by 11 publications

(17 citation statements)

References 42 publications

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“…Similar observations are seen with the use of HACS. Until now, HiSS has only been described in case reports, with the largest series demonstrating promising results in 5 patients 10–12 . Our study endorses these results by providing data of 39 patients with a high anterior approach demonstrating less blood loss, shorter operating times, and less wound-related complications compared with PS, while maintaining good oncological results with R0 rates of 76.9% and a positive sacral transection margin in only 2/39 patients (5.1%).…”

Section: Discussionsupporting

confidence: 76%

“…The benefits of this technique are preservation of pelvic stability, reducing neurological morbidity, avoidance of an extensive perineosacral wound, and reducing operating time as there is no need to turn the patient into prone position. [10][11][12] Most literature on PE with en-bloc sacrectomy has focused on complications, quality of life outcomes, or level of sacrectomy, with most studies incorporating patients with (recurrent) rectal cancer only. [13][14][15][16][17] Although technical reports for the various sacrectomy approaches are available, data comparing the various techniques is limited.…”

mentioning

confidence: 99%

“…In addition, we introduced the less frequently described technique of high anterior cortical sacrectomy (HACS) for patients with high sacral tumors (S2 and above). The benefits of this technique are preservation of pelvic stability, reducing neurological morbidity, avoidance of an extensive perineosacral wound, and reducing operating time as there is no need to turn the patient into prone position 10–12 …”

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confidence: 99%

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Improving Surgical Outcomes in Pelvic Exenteration Surgery

et al. 2023

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Objective: To assess the effect of changing our sacrectomy approach from prone to anterior on surgical and oncological outcomes. Background: In patients with advanced pelvic malignancy involving the sacrum, pelvic exenteration (PE) with en-bloc sacrectomy is the only potential curative option but morbidity is high. Over time sacrectomy techniques have evolved from prone sacrectomy (PS) to abdominolithotomy sacrectomy (ALS, S3) and high anterior cortical sacrectomy (HACS, >S3) to optimize surgical outcomes. Methods: A retrospective, single institution analysis of prospectively collected data for patients undergoing PE with en-bloc sacrectomy between 1994 and 2021 was performed. Results: 363 patients were identified and divided into PS (n=77, 21.2%), ALS (n=247, 68.0%) and HACS (n=39, 10.7%). Indications were: locally advanced (n=92) or recurrent (n=177) rectal cancer, primary other (n=31), recurrent other (n=60) and benign disease (n=3). PS resulted in longer operating time (P<0.01) and more blood loss (P<0.01). Patients with HACS had more major nerve (87.2%) and vascular (25.6%) resections (P<0.01). VRAM flap repair was less common following HACS (7.7%) than ALS (25.5%) and PS (27.3%) (P=0.040). R0 rate was 80.8%, 65.8% and 76.9% following ALS, PS and HACS, respectively (P=0.024). Wound-related complications and re-operations were significantly reduced following ALS and HACS compared to PS. Conclusion: Changing our practice from PS to an anterior approach with ALS or HAS has been safe and improved overall surgical and peri-operative outcomes, while maintaining good oncological outcomes. Given the improved peri-operative and surgical outcomes, it would be important for surgeons to learn and adopt the anterior sacrectomy approaches.

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Section: Discussionsupporting

confidence: 76%

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confidence: 99%

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confidence: 99%

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Improving Surgical Outcomes in Pelvic Exenteration Surgery

et al. 2023

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“…The amplitude of sacral resection is based on the experience of the surgeon, lesion extension and nervous tissue infiltration. 3 Total sacrectomy is bilateral resection and fixation of the dural sac below S1, with resection extended to L5, L4, and to the iliac region, if necessary. 7 It normally occurs in two stages: an anterior approach and a posterior approach.…”

Section: Palavras-chavementioning

confidence: 99%

Partial Sacrectomy in the Management of Sacral Chordoma: Case Report and Literature Review

Santos,

Maximiano,

Cortez

2024

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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Chordomas are rare neoplasms of low to intermediate grades, which arise from ectopic remnants of notochordal tissue, presenting a slow growth pattern and locally aggressive behavior. Due to their insidious course, the diagnosis is late, requiring immediate therapeutic intervention. The main prognostic factor is total surgical resection with wide margins. This therapeutic objective is only achieved in 40% to 55.6% of the cases, since chordoma tends to present an aggressive behavior, invading adjacent tissues and neurovascular structures. Currently, the main challenge of sacrectomy is to balance a wide resection with the preservation of the neurological function of the patient. Despite cases of successful gross total resection, local recurrence is an inevitable reality, and the overall survival is relatively low. The indication of adjuvant therapies is not well stablished in the literature, since the response to radiotherapy is not satisfactory for these tumors. The aim of the present study is to present a report the case of a patient with sacral chordoma (SC) who underwent partial sacrectomy and to carry out a brief review of the literature on sacrococcygeal chordomas.

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“…Sacrectomy can be divided into low (S3 and below) and high (S2 and above) sacrectomy where low sacrectomy usually can be performed through an abdominolithotomy approach, while high sacrectomy often requires prone position. Alternative options avoiding prone position can be central high anterior subcortical sacrectomy if technically feasible depending on tumour location [ 46 ].…”

Section: Optimizing Surgical Strategies; Key To Improve Surgical and ...mentioning

confidence: 99%

Understanding the Philosophy, Anatomy, and Surgery of the Extra-TME Plane of Locally Advanced and Locally Recurrent Rectal Cancer; Single Institution Experience with International Benchmarking

Kessel

Solomon

2022

Cancers

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Pelvic exenteration surgery has become a widely accepted procedure for treatment of locally advanced (LARC) and locally recurrent rectal cancer (LRRC). However, there is still unwarranted variation in peri-operative management and subsequently oncological outcome after this procedure. In this article we will elaborate on the various reasons for the observed differences based on benchmarking results of our own data to the data from the PelvEx collaborative as well as findings from 2 other benchmarking studies. Our main observation was a significant difference in extent of resection between exenteration units, with our unit performing more complete soft tissue exenterations, sacrectomies and extended lateral compartment resections than most other units, resulting in a higher R0 rate and longer overall survival. Secondly, current literature shows there is a tendency to use more neoadjuvant treatment such as re-irradiation and total neoadjuvant treatment and perform less radical surgery. However, peri-operative chemotherapy or radiotherapy should not be a substitute for adequate radical surgery and an R0 resection remains the gold standard. Finally, we describe our experiences with standardizing our surgical approaches to the various compartments and the achieved oncological and functional outcomes.

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Towards Standardisation of Technique for En Bloc Sacrectomy for Locally Advanced and Recurrent Rectal Cancer

Cited by 11 publications

References 42 publications

Improving Surgical Outcomes in Pelvic Exenteration Surgery

Improving Surgical Outcomes in Pelvic Exenteration Surgery

Partial Sacrectomy in the Management of Sacral Chordoma: Case Report and Literature Review

Understanding the Philosophy, Anatomy, and Surgery of the Extra-TME Plane of Locally Advanced and Locally Recurrent Rectal Cancer; Single Institution Experience with International Benchmarking

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