Open AccessComposite abdominosacral resection for recurrent rectal cancer
Author(s) -
Sagar P. M.,
Gonsalves S.,
Heath R. M.,
Phillips N.,
Chalmers A. G.
Publication year - 2009
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1002/bjs.6464
Subject(s) - medicine , colorectal cancer , surgery , sacrum , magnetic resonance imaging , confidence interval , rectum , resection , stoma (medicine) , splenic flexure , cancer , positron emission tomography , radiology , colonoscopy
Background: En bloc resection of the tumour and adjacent involved organs offers the only realistic curative option for patients with locally recurrent rectal cancer. This study assessed outcomes of composite resection for recurrent tumours involving the sacrum. Methods: A consecutive series of patients underwent composite abdominosacral resection (abdominal mobilization and stoma construction followed by sacral division and tumour retrieval) for recurrent rectal cancer between 2001 and 2007. Patients were staged with preoperative computed tomography, magnetic resonance imaging and positron emission tomography. Data were collected prospectively. Results: Forty patients (28 men; median age 59 (range 31–77) years) underwent surgery with sacral division at the S2/3 interface in 13, S3/4 level in 20 and S4/5 level in seven patients. One patient died and 24 had complications. An R0 resection was achieved in 20 patients and conferred benefit in disease‐free interval over an R1 resection. The mean disease‐free interval was 55·6 (95 per cent confidence interval (c.i.) 40·0 to 71·3) months for R0 and 32·2 (95 per cent c.i. 19·7 to 44·7) months for R1 resection ( P = 0·048). Conclusion: Composite abdominosacral resection of locally recurrent rectal cancer is an effective treatment for a difficult clinical scenario. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.