*Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney †Department of Colorectal Surgery, Royal Prince Alfred Hospital ‡Discipline of Surgery, University of Sydney §Cancer Epidemiology and Services Research, Sydney School of Public Health, University of Sydney ¶Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Ann Surg. 2013 Dec;258(6):1007-13. doi: 10.1097/SLA.0b013e318283a5b6.
To describe the experience of sacrectomy with extended radical resection in the treatment of locally recurrent rectal cancer.
Resections of the bony pelvis, especially the sacrum, are becoming more common as part of extended radical exenterations for patients with recurrent rectal cancer. However, sacrectomy has been shown to carry a significant decrease in survival. Morbidity rates have been associated with the level of the sacrectomy (ie, >S3 junction).
An analysis was conducted using prospective data from patients with recurrent rectal cancer who underwent pelvic exenteration involving sacrectomy from July 1998 until June 2011. The impact of the proximal level of sacrectomy [low (≤S3) vs high (≥S2-S3 disc)] was compared.
Of 240 exenteration patients, 79 underwent sacrectomy, with 49 for recurrent rectal cancer. An R0 margin was achieved in 36 (74%) patients. Achievement of clear operative margins (R0) conferred a large and significant benefit for disease-free survival compared with R1 and R2 resections (median 45 months vs 19 and 8 months, respectively; P = 0.045). Complications were reported in 40 (82%) patients, with major and minor complications in 19 (39%) and 38 (78%) patients, respectively. The proximal level of the sacrectomy (high vs low) did not significantly impair the ability to achieve a clear margin and was not associated with an increase in major or minor complications.
This large, single-center series has demonstrated that extended pelvic exenteration involving sacrectomy has excellent R0 margins and survival rates for recurrent rectal cancer. A high sacrectomy has comparable results with a more distal abdominosacral resection.
描述局部复发性直肠癌行扩大根治性切除术的骶骨切除术经验。
作为复发性直肠癌患者广泛根治性切除术的一部分，骨盆骨骼，特别是骶骨的切除术越来越常见。然而，骶骨切除术已被证明会显著降低生存率。发病率与骶骨切除术的水平有关（即>S3 交界处）。
对 1998 年 7 月至 2011 年 6 月期间接受包括骶骨切除术的骨盆切除术的复发性直肠癌患者的前瞻性数据进行了分析。比较了骶骨近端水平（低[≤S3]与高[≥S2-S3 椎间盘]）的影响。
在 240 例切除术患者中，79 例行骶骨切除术，其中 49 例为复发性直肠癌。36 例（74%）患者达到了 R0 切缘。与 R1 和 R2 切除相比，达到清晰手术切缘（R0）对无病生存有显著的获益（中位 45 个月 vs 19 个月和 8 个月，P=0.045）。40 例（82%）患者出现并发症，19 例（39%）和 38 例（78%）患者出现严重和轻微并发症。骶骨切除术的近端水平（高 vs 低）并未显著影响达到清晰切缘的能力，与严重或轻微并发症的增加无关。
这项大型单中心研究表明，涉及骶骨切除术的广泛骨盆切除术对复发性直肠癌具有极佳的 R0 切缘和生存率。高位骶骨切除术与更低位的腹骶切除术结果相当。
