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Extended Sacropelvic Resection For Locally Recurrent Rectal Cancer: Can It Be Done Safely and With Good Oncologic Outcomes?

Colibaseanu, Dorin T. M.D.1; Dozois, Eric J. M.D.1; Mathis, Kellie L. M.D.1; Rose, Peter S. M.D.2; Ugarte, Maria L. Martinez M.D.1; Abdelsattar, Zaid M. M.D.1; Williams, Michael D. D.O.1; Larson, David W. M.D.1

Diseases of the Colon & Rectum: January 2014 - Volume 57 - Issue 1 - p 47–55
doi: 10.1097/DCR.0000000000000015
Original Contributions: Colorectal/Anal Neoplasia

BACKGROUND: A multimodality approach to patients with locally recurrent rectal cancer that includes surgery is associated with a significant survival advantage when tumor-free margins are achieved. Patients with advanced tumors will require extended sacropelvic resection to optimize oncologic outcomes.

OBJECTIVE: The aim of this study was to assess the safety, feasibility, and oncologic outcomes of extended sacropelvic resection for locally recurrent rectal cancer at our institution.

DESIGN: A retrospective review identified 406 patients who had surgery for locally recurrent rectal cancer between 1997 and 2007. From this group, all patients who underwent a curative-intent sacropelvic resection were analyzed.

SETTINGS: This investigation was conducted at an academic tertiary referral center.

PATIENTS: Thirty patients (24 male) were identified. Median age was 59 years (range, 25–84). Operations were performed for a first local recurrence (n = 24), a second recurrence (n = 5) and for a third recurrence (n = 1).

INTERVENTIONS: Twenty-six patients underwent neoadjuvant radiation, and 20 received intraoperative radiation therapy. All patients underwent extended sacropelvic resection.

MAIN OUTCOME MEASURES: The primary outcomes measured were early (<30 days) and late (>30 days) surgical complications. Overall and disease-free survivals were estimated by using the Kaplan-Meier technique.

RESULTS: Margin-negative resection was achieved in 93%. The most proximal level of spinal transection was the fourth lumbar space, and 4 patients underwent lower extremity amputation. There was no mortality, and early morbidity was seen in 76%. Median follow-up was 2.7 years (range, 2 months to 10.8 years). Overall survival at 2 and 5 years was 86% and 46%. Disease-free survival at 2 and 5 years was 79% and 43%.

LIMITATIONS: This study was limited by its retrospective nature and the limited number of patients.

CONCLUSIONS: We found extended sacropelvic resection for locally recurrent rectal cancer to be feasible and safe with overall and disease-free survival rates in comparison with survival rates seen in patients undergoing nonsacropelvic resections for locally recurrent rectal cancer.

See related article on p. 1

1Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota

2Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

Financial Disclosure: None reported.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, Phoenix, AZ, April 27 to May 2, 2013.

Correspondence: Eric J. Dozois, M.D, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail: Dozois.Eric@mayo.edu

© 2014 The American Society of Colon and Rectal Surgeons