Feasibility and Oncological Outcomes of Sacral Resection for Locally Advanced and Recurrent Rectal Cancer : A Single...

Sacral resection in rectal cancer is a challenging surgical procedure indicated in locally advanced or recurrent disease with posterior fixation. Advances in imaging and surgical techniques have made such resections more feasible in specialized centers with improved outcomes. Careful selection of patients and multidisciplinary team involvement has shown significant improvement in surgical and oncological outcomes. This retrospective study analyzed 19 patients who underwent sacral resection for locally advanced / locally recurrent rectal cancer at a tertiary cancer center from February 2017 to December 2021. Patient demographics, surgical details, postoperative morbidity, recurrence, and survival outcomes were studied. Statistical analysis was performed using SPSS software using descriptive analysis for general demographic data and Kaplan Meier function for survival analysis. All patients underwent surgery post-neoadjuvant therapy. R0 resection was achieved in all cases. Median operative time was 352 min; average blood loss was 2180 mL. All resections were Mid and low sacral resections (S2-S3: 4, S3-S4:6, S4-S5:9). Immediate complications were mainly wound-related (47%) and long term complications were predominantly urological (40% with preserved bladder). There was no 30-day mortality. Twelve of the nineteen patients had recurrences, commonest recurrence was distant metastasis (liver) with only 2 local recurrences. The mean recurrence-free survival was 16.4 months, and 5-year survival probability was 31.6%. On univariate analysis lympovascular space invasion was the only one found to have significant influence on survival (p-0.03). Sacral resection is feasible, safe, and oncologically sound when performed for selected patients with rectal cancer with sacral invasion. Meticulous planning and a multidisciplinary approach are critical to optimizing outcomes.