Abdominosacral resection for locally advanced and recurrent rectal cancer.
SourceBritish Journal of Surgery, 96, 11, (2009), pp. 1341-1347
Article / Letter to editor
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British Journal of Surgery
SubjectONCOL 1: Hereditary cancer and cancer-related syndromes; ONCOL 4: Quality of Care
BACKGROUND: The results of resection of locally advanced and recurrent rectal cancers, including sacral resection, were analysed critically. METHODS: Between 1987 and 2007, 353 patients with locally advanced or recurrent rectal cancer, all treated in a tertiary referral centre, were identified from a prospective database. Twenty-five patients (eight primary and 17 recurrent tumours) underwent en bloc sacral resection. RESULTS: A mid-sacral resection was carried out in 12 patients (level S3) and a low sacral resection in 13 (level S4/S5). Nineteen patients had an R0, four an R1 and two an R2 resection. There was no postoperative mortality. Median follow-up was 32 months. Incomplete resection had an independent negative influence on local control (5-year local recurrence rate 42 versus 0 per cent in those with and without incomplete resection; P < 0.001). The 5-year overall survival rate was 30 per cent. Five patients with recurrent tumour had pathological invasion into the sacral bone and none survived beyond 1 year. CONCLUSION: Abdominosacral resection can be performed in patients with locally advanced and recurrent rectal cancer. Patients who cannot undergo a complete resection or have clear evidence of cortical invasion have a poor prognosis.
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