Abdominosacral resection for rectal cancer

Abstract

Abdomino-sacral resection is an operation that is usually performed to resect recurrent rectal cancers that invade the sacrum. Occasionally it may be performed to treat advanced primary rectal cancers with threatened posterior margins or direct invasion into the sacrum. It is a procedure combined of an abdominal and perineal/sacral part aiming to resect the tumor en bloc with the adjacent structures. It carries a significant risk for mortality and morbidity. The mortality in recent years has been reported to range up to 3.5 %. This is usually secondary to a major complication. Morbidity is considered significant and ranges up to 70 %. Complete resection can be achieved up to 100 % of the operated patients but the majority of the studies report rates at the range of 55-70 %. This variation is likely due to patient selection. The overall 5-year survival following surgery ranges between 30 and 45 % with complete resection being the most important predictor for overall and disease free survival. Abdominosacral resection should be offered in carefully selected patients and carried out at tertiary centers with experience in this type of procedure for optimal results.