Abdominosacral resection for primary irresectable and locally recurrent rectal cancer

GHH Mannaerts, HJT Rutten*, H Martijn, G.J. Groen, PEJ Hanssens, T Wiggers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

85 Citations (Scopus)

Abstract

PURPOSE: The purpose of this study was to present a technique of abdominosacral resection and its results in patients with locally advanced primary or locally recurrent rectal cancer with dorsolateral fixation. METHODS: Between 1994 and 1999, 13 patients with locally advanced primary rectal cancer and 37 patients with locally recurrent rectal cancer underwent abdominosacral resection as part of a multimodality treatment, i.e., preoperative irradiation, surgery, and Intraoperative irradiation. After the abdominal phase, the patient was turned from supine to prone position to perform the transsacral phase of the resection. RESULTS: Margins were microscopically negative in 26 patients (52 percent), microscopically positive in 18 (36 percent), and positive with gross residual disease in 6 patients. Operation time ranged from 210 to 590 (median, 390) minutes, and blood loss ranged from 400 to 10,000 (median, 3,500) ml. No operative or hospital deaths occurred. Postoperative complications occurred in 41 patients (82 percent); most notable were perineal wound infections or dehiscence (n = 24, 48 percent). Other complications were postoperative urinary retention or incontinence (n = 9, 18 percent), peritonitis (n = 4), grade II neuropathy (n = 1), and fistula formation (n = 3). Kaplan-Meier 3-year overall survival, disease-free survival, and local control rates were, respectively, 41 percent, 31 percent, and 61 percent. Completeness of the resection (negative vs. positive margins) was a significant factor influencing survival (P = 0.04), disease-free survival (P = 0.0006), and local control (P = 0.0002). CONCLUSION: The abdominosacral resection provides wide access and may be the therapeutic solution for the accomplishment of a radical resection for distally situated, dorsally or dorsolaterally fixed primary or locally recurrent rectal cancers.

Original languageEnglish
Pages (from-to)806-814
Number of pages9
JournalDISEASES OF THE COLON & RECTUM
Volume44
Issue number6
Publication statusPublished - Jun-2001
Event10th Annual Meeting of the European-Society-of-Surgical-Oncology - , Netherlands
Duration: 5-Apr-20008-Apr-2000

Keywords

  • abdominosacral
  • sacral resection
  • transsacral
  • locally advanced
  • locally recurrent
  • rectal cancer
  • intraoperative radiation
  • external-beam radiotherapy
  • INTRAOPERATIVE RADIATION-THERAPY
  • EXTERNAL-BEAM IRRADIATION
  • COLORECTAL-CANCER
  • SACRAL RESECTION
  • PELVIC EXENTERATION
  • SURGICAL-MANAGEMENT
  • ANORECTAL CANCER
  • RADICAL SURGERY
  • RADIOTHERAPY
  • CARCINOMA

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