• Tony Milne, Michael J Solomon, Peter Lee, Jane M Young, Paul Stalley, James D Harrison, and Kirk K S Austin.
• 1Surgical Outcomes Research Centre, Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia 2Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia 3Discipline of Surgery, University of Sydney, Sydney, New South Wales, Australia 4Cancer Epidemiology and Services Research, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia 5Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
• Dis. Colon Rectum. 2014 Oct 1; 57 (10): 1153-61.

BackgroundRecurrent 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.ObjectiveThis study aimed to analyze the morbidity and survival associated with pelvic exenteration involving sacrectomy for advanced pelvic cancers at a single institution.DesignThis study used patient demographics, operative and pathologic reports, and prospective survival data to determine factors affecting patient outcomes.SettingsData were collected for patients who had operations between July 1998 and April 2012 at Royal Prince Alfred Hospital.PatientsOne hundred patients underwent pelvic exenteration with a sacrectomy for advanced pelvic cancers. Sacrectomy was performed for 18 primary and 61 recurrent rectal cancers, 17 anal cancers, and 4 other cancers.Main Outcome MeasuresThis 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.ResultsClear 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.LimitationsRetrospective data were required to analyze patient morbidity, as well as operative and pathologic factors.ConclusionsThis 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.

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