• Brown Kilian G M KGM Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia. , Michael J Solomon, Yee Chen Lau, Daniel Steffens, Austin Kirk K S KKS Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia. S, and Peter J Lee.
• Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
• Ann. Surg. 2021 May 1; 273 (5): 982-988.

ObjectiveTo report survival, functional, and quality-of-life (QoL) outcomes after extended radical resection for advanced pelvic tumors with en bloc sciatic or femoral nerve resection.BackgroundAdvanced pelvic tumors involving the sciatic or femoral nerve have traditionally been considered inoperable. Small studies have suggested acceptable functional outcomes can be achieved after pelvic exenteration with en bloc sciatic nerve resection.MethodConsecutive patients who underwent extended radical pelvic surgery with en bloc resection of the sciatic or femoral nerves at a single center were included.ResultsOf 713 radical pelvic resections, 68 patients (9.5%) had en bloc sciatic or femoral nerve resection. Complete sciatic, partial sciatic, and complete femoral nerve resection was performed in 26 (38%), 38 (56%), and 4 patients (6%), respectively. Overall and major postoperative complication rates were 63% and 40%, respectively. R0 resection was achieved in 65% of patients, which translated to 55% and 76% overall and local recurrence-free 5-year survival in those with colorectal cancer. Twenty-two (96%) and 25 (92%) patients could mobilize independently after complete and partial sciatic nerve resection, respectively. Physical QoL was significantly lower at 6 months after surgery compared with baseline (P = 0.041), but returned to baseline at 12 months (P = 0.163). There was no difference in mental or overall QoL at 6 or 12 months compared with baseline.ConclusionEn bloc sciatic and femoral nerve resection can be performed during extended radical pelvic resections with morbidity and survival outcomes comparable with existing exenteration literature, including in patients with recurrent rectal cancer. Physical QoL may be impaired after surgery, but returns to baseline by 12 months.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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