Abstract
PURPOSE: To provide local control and palliation of pain, a multimodality approach, including external beam radiation therapy, surgical resection, and intraoperative electron irradiation (IOERT), has been used for patients with locally advanced anal or recurrent rectal cancers involving the sacrum. METHODS: Sixteen consecutive patients (11 males; 5 females; ages, 44–76) underwent surgical exploration, sacrectomy, and IOERT, between 1990 and 1994. RESULTS: Proximal extent of resection was S2–3 in four patients, S3–4 in five, and S4–5 in five. Two patients had resection of the anterior table of the sacrum. Margins were clear in 11, close in 3, and microscopically involved in 2 patients. Operative times ranged from 6 to 17 (median, 12.5) hours, and blood loss ranged from 300 to 12,600 (median, 3,350) ml. No operative deaths resulted. Major postoperative complications occurred in eight patients (50 percent): posterior wound infections and dehiscence, urinary leak, and ileal fistula. Five (31 percent) and 3 (19 percent) patients developed no or minor complications, respectively. Intensive Care Unit stay was one night for all patients, and overall hospital stay ranged from 11 to 30 (median, 16.5) days. Follow-up was available on all 16 patients. Kaplan-Meier survival was 68 percent at one year and 48 percent at two years. At the time of analysis, 9 of 16 patients were alive. Of the nine alive patients who responded to a questionnaire, eight reported a reduction in pain and improved quality of life postoperatively. CONCLUSIONS: Sacropelvic resection, in conjunction with IOERT, provides palliation and offers potential for cure in patients with locally advanced or recurrent anorectal cancer.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Berge T, Ekelund G, Mellner C, Pihl B, Wenckert A. Carcinoma of the colon and rectum in a defined population. Acta Chir Scand 1973;438(Suppl):1–86.
Gunderson LL, Sosin H. Areas of failure found at reoperation (second or symptomatic look) following “curative surgery” for adenocarcinoma of the rectum. Cancer 1974;34:1278–92.
Cass AW, Million RR, Pfaf W. Patterns of recurrence following surgery alone for adenocarcinoma of the colon and rectum. Cancer 1976;37:2861–5.
Rao AR, Kagan AR, Chan PM, Gilbert HA, Nussbaum H, Hintz BL. Patterns of recurrence following curative resection alone for adenocarcinoma of the rectum and sigmoid colon. Cancer 1981;48:1492–5.
Rich T, Gunderson LL, Lew R, Galdibini JJ, Cohen AM, Donaldson G. Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer 1983;52:1317–29.
Pilipshen SJ, Heilweil M, Quan SH, Sternberg SS, Enker WE. Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer 1984;53:1354–62.
McDermott FT, Hughes ES, Pihl E, Johnson WR, Price AB. Local recurrence after potentially curative resection for rectal cancer in a series of 1008 patients. Br J Surg 1985;72:34–7.
Carlsson U, Lasson A, Ekelund G. Recurrence rates after curative surgery for rectal carcinoma, with special reference to their accuracy. Dis Colon Rectum 1987;30:431–4.
Stipa S, Nicolanti V, Botti C,et al. Local recurrence after curative resection for colorectal cancer: frequency, risk factors and treatment. J Surg Oncol Suppl 1991;2:155–60.
Taylor FW. Cancer of the colon and rectum: a study of routes of metastases and death. Surgery 1962;52:305–8.
Floyd CE, Corley RG, Cohn I Jr. Local recurrence of carcinoma of the colon and rectum. Am J Surg 1965;109:153–9.
Maetani S, Nishikawa T, Iijima Y,et al. Extensive en bloc resection of regionally recurrent carcinoma of the rectum. Cancer 1992;69:2876–83.
Minsky BD, Kemeny N, Cohen AM,et al. Preoperative high-dose leucovorin/5-fluorouracil and radiation therapy for unresectable rectal cancer. Cancer 1991;67:2859–66.
Minsky BD, Cohen AM, Kemeny N,et al. The efficacy of preoperative 5-fluorouracil, high-dose leucovorin, and sequential radiation therapy for unresectable rectal cancer. Cancer 1993;71:3486–92.
Gunderson LL, Cohen AM, Dosoretz DE,et al. Residual, unresectable, or recurrent colorectal cancer: external beam irradiation and intraoperative electron beam boost ± resection. Int J Radiat Oncol Biol Phys 1983;9:1597–1606.
Tepper JE, Cohen AM, Wood WC, Hedberg SE, Orlow E. Intraoperative electron beam radiotherapy in the treatment of unresectable rectal cancer. Arch Surg 1986;121:421–3.
Beart RW Jr, Martin JK Jr, Gunderson LL. Management of recurrent rectal cancer. Mayo Clin Proc 1986;61:448–50.
Gunderson LL, Martin JK, Beart RW,et al. Intraoperative and external beam irradiation for locally advanced colorectal cancer. Ann Surg 1988;207:52–60.
Avizonis VN, Sause WT, Noyes RD. Morbidity and mortality associated with intraoperative radiotherapy. J Surg Oncol 1989;41:240–5.
Willett CG, Shellito PC, Tepper JE, Eliseo R, Convery K, Wood WC. Intraoperative electron beam radiation therapy for recurrent locally advanced rectal or rectosigmoid carcinoma. Cancer 1991;67:1504–8.
Gunderson LL, Dozois RR. Intraoperative irradiation for locally advanced colorectal carcinomas. Perspect Colon Rectal Surg 1992;5:1–23.
Gunderson LL, Martenson JA, Kvols LK, Devine RM, Beart RW. Indications for and results of intraoperative irradiation for locally advanced colorectal cancer. Front Radiat Ther Oncol 1991;25:284–306.
Suzuki K, Gunderson LL, Devine RM,et al. Intraoperative irradiation after palliative surgery for locally recurrent rectal cancer. Cancer 1995;75:939–52.
MacCarty CS, Waugh JM, Mayo CW, Coventry MB. The surgical treatment of presacral tumors: a combined problem. Mayo Clin Proc 1952;27:73–84.
Sundaresan N, Huvos AG, Krol G, Lane JM, Brennan M. Surgical treatment of spinal chordomas. Arch Surg 1987;122:1479–82.
Wanebo HJ, Koness RJ, Vezeridis MP, Cohen SI, Wrobleski DE. Pelvic resection of recurrent rectal cancer. Ann Surg 1994;220:586–97.
Pearlman NW, Stiegmann GV, Donohue RE. Extended resection of fixed rectal cancer. Cancer 1989;63:2438–41.
Temple WJ, Ketcham AS. Sacral resection for control of pelvic tumors. Am J Surg 1992;163:370–4.
Touran T, Frost DB, O'Connell TX. Sacral resection: operative technique and outcome. Arch Surg 1990;125:911–3.
Wanebo HJ, Gaker DL, Whitehill R, Morgan RF, Constable WC. Pelvic recurrence of rectal cancer: options for curative resection. Ann Surg 1987;205:482–95.
Ketcham AS. The management of recurrent rectal carcinoma. Can J Surg 1985;28:422–7.
Wanebo HJ, Koness RJ, Turk PS, Cohen SI. Composite resection of posterior pelvic malignancy. Ann Surg 1992;215:685–95.
Astler VB, Coller FA. The prognostic significance of direct extension of carcinoma of the colon and rectum. Ann Surg 1954;139:846–51.
Author information
Authors and Affiliations
Additional information
Supported in part by a grant from the Centro Nazionale Ricerche, (National Institute of Scientific Research), Rome, Italy and American Cancer Society Career Development Award.
Read at meeting of The American Society of Colon & Rectal Surgeons, Montreal, Quebec, Canada, May 7 to 12, 1995.
About this article
Cite this article
Magrini, S., Nelson, H., Gunderson, L.L. et al. Sacropelvic resection and intraoperative electron irradiation in the management of recurrent anorectal cancer. Dis Colon Rectum 39, 1–9 (1996). https://doi.org/10.1007/BF02048260
Issue Date:
DOI: https://doi.org/10.1007/BF02048260