Abstract | BACKGROUND: Recurrent and advanced primary pelvic cancers present a complex clinical issue requiring multidisciplinary care and radical extended surgery. Sacral resection is necessary for tumors that invade posteriorly but is associated with increased morbidity and mortality. OBJECTIVE: DESIGN: This study used patient demographics, operative and pathologic reports, and prospective survival data to determine factors affecting patient outcomes. SETTINGS: Data were collected for patients who had operations between July 1998 and April 2012 at Royal Prince Alfred Hospital. PATIENTS: MAIN OUTCOME MEASURES: This study looked at postoperative major and minor morbidity rates, as well as disease-free and overall survival rates after sacral resection. It compared the outcomes of high sacrectomy (at or above S2) versus low sacrectomy. RESULTS: Clear margins were achieved in 72 of 100 patients. The overall complication rate was 74% (43% major and 67% minor) with no 30-day or in-hospital mortality. Estimated overall and disease-free survival rates after curative resection were 38% and 30% at 5 years. Involved margins (p = 0.006), lymph node involvement (p = 0.008), and anterior organ invasion (p = 0.008) had a negative impact on patient survival. High sacrectomy increased the incidence of neurologic deficit postoperatively (p = 0.04) but did not alter the rate of R0 resection or patient survival. LIMITATIONS: Retrospective data were required to analyze patient morbidity, as well as operative and pathologic factors. CONCLUSIONS: This series supports sacral resection for curative surgery in advanced pelvic cancers, achieving excellent R0 and long-term survival rates. Cortical bone invasion and high sacrectomy were not contraindications to surgery and had acceptable outcomes.
|
Authors | Tony Milne, Michael J Solomon, Peter Lee, Jane M Young, Paul Stalley, James D Harrison, Kirk K S Austin |
Journal | Diseases of the colon and rectum
(Dis Colon Rectum)
Vol. 57
Issue 10
Pg. 1153-61
(Oct 2014)
ISSN: 1530-0358 [Electronic] United States |
PMID | 25203370
(Publication Type: Journal Article)
|
Topics |
- Adenocarcinoma
(secondary, surgery)
- Adult
- Aged
- Anastomotic Leak
(etiology)
- Anus Neoplasms
(pathology, surgery)
- Carcinoma, Squamous Cell
(secondary, surgery)
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Ileus
(etiology)
- Male
- Middle Aged
- Neoplasm Recurrence, Local
(surgery)
- Pelvic Exenteration
(adverse effects)
- Peripheral Nerve Injuries
(etiology)
- Rectal Neoplasms
(pathology, surgery)
- Retrospective Studies
- Sacrum
(pathology, surgery)
- Surgical Wound Infection
(etiology)
- Survival Rate
- Urinary Incontinence
(etiology)
- Urinary Retention
(etiology)
- Urinary Tract Infections
(etiology)
|