Pelvic Exentration and Composite Sacral Resection in the Surgical Treatment of Locally Recurrent Rectal Cancer
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- Category: Vol. 82, March 2014
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Pelvic Exentration and Composite Sacral Resection in the Surgical Treatment of Locally Recurrent Rectal Cancer, WAEL S. ABD EL-GAWAD, MEDHAT KHAFAGY, MOHAMED GAMIL, IBRAHIM FAKHR, MOUSTAFA NEGM, NADIA MOKHTAR, MOHAMED LOUTAEF and OSMAN MANSOUR
Abstract
Background: The incidence of rectal cancer recurrence after surgery is 5-45%. Extended Pelvic resection such as pelvic exentration and abdominosacral composite resection which entails En-bloc resection of the tumor and adjacent involved organs provide the only true possible curative option for patients with locally recurrent rectal cancer.
The Aim of this Study: Is to evaluate the surgical and oncological outcome of such treatment.
Patients and Methods: Between 2006 and 2012 a consec-utive series of 40 patients with locally recurrent rectal cancer underwent abdominosacral resection (ASR) in 18 patients, total pelvic exentration with sacral resection in 10 patients and pelvic exentration in 12 patients. Patients with sacral resection were 28, with the level of sacral division at S2-3 interface in 10 patients, at S3-4 in 15 patients and S4-5 in 3 patients.
Results: Forty patients, male to female ratio 1.7:1, mean age 45 years (range 25-65Y) underwent extended pelvic resection in the form of pelvic exentration and Abdominosacral resection. Blood lossrange was (0.4-6L). Median hospital stay was 21 (range 7-52) days. The Morbidity, Readmission and Mortality rates were 55%, 15%, and 5% respectively. The reported surgical complications were as such wound gap in 10 patients, neurogenic bladder in 9 patients, and enteric fistula in 9 patients. Mortality occurred in 2 patients due to enteric fistula and abdominal sepsis. A R0 and R1 sacral resection were achieved in 63% and 37% respectively. Thirty five patients underwent curative resection and showed signif-icantly improved survival with 5-year survival rate of 26.3% compared to 5 patients with palliative resection in a survival rate of 0%.
Conclusion: Extended pelvic resection as pelvic exentra-tion and sacral resection for locally recurrent rectal cancer are effective procedures with tolerable mortality rate and acceptable outcome. The associated morbidity remains high and deserves vigilant follow-up.