Background: The management of recurrent rectal cancer is challenging. At the present time pelvic exenteration with en bloc sacrectomy offers the only hope of lasting cure.
Objective: The purpose of this study was to evaluate clinical outcome measures and complication rates following sacrectomy for recurrent rectal cancer.
Data Sources: Search conducted on ‘Pub Med’ for English language articles relevant to sacrectomy for recurrent rectal cancer with no time limitations.
Study Selection: Studies reported sacrectomy with survival data for recurrent rectal adenocarcinoma.
Main outcome measure: Disease free survival following sacrectomy for recurrent rectal cancer.
Results: A total of 220 recurrent rectal cancer patients were included from 7 studies, of which 160 were male and 60 were female. Overall median operative time was 717 (570-992) minutes and blood loss was 3.7 (1.7-6.2) litres. An R0 (>1mm resection margin) resection was achieved in 78% of patients. Disease free survival associated with R0 resection was 55% at a median follow up period of 33 (17-60) months; however, none of the patients with R1 (<1mm resection margin) survived this period. Postoperative complication rates and median length of stay were found to decrease with more distal sacral transection levels. In contrast, R1 resection rates increased with more distal transection.
Limitation: The studies assessed by this review were retrospective case series and thus are subject to significant bias.
Conclusion: Sacrectomy performed for patients with recurrent rectal cancer is associated with significant postoperative morbidity. Morbidity and post-operative length of stay increase with the level of sacral transection. Nevertheless, approximately half of patients eligible for rectal excision with en bloc sacrectomy may benefit from disease free survival for up to 33 months, with R0 resection predicting disease free survival in the medium term.