Related Experiment Video
Updated: Aug 12, 2026
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
A Systematic Three-Step Posterior Sacral Resection for High Sacrectomy (S2 and Below) in Pelvic Malignancies
Chongqing Gao1, Shuo Li1, Tao Wang1
1Department of Abdominal and Pelvic Tumor Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Background:
Achieving R0 resection in pelvic solid malignancies significantly prolongs survival. However, when these tumors involve the high sacrum (S2 and below), the procedure is often deemed contraindicated due to technical complexity and substantial perioperative risks.
Objective:
To describe a standardized three-step posterior sacral resection technique for high sacrectomy and evaluate its perioperative and oncological outcomes.
Design:
Retrospective cohort study.
Settings:
Department of Abdominal and Pelvic Tumor Surgery, The First Affiliated Hospital of Zhengzhou University, and Department of General Surgery, Henan Cancer Hospital.
Patients:
A total of 47 patients with pelvic solid malignancies (recurrent rectal cancer, chordoma, or presacral malignant teratoma) invading the high sacrum (S2 and below) who underwent surgery between January 2018 and December 2024.
Intervention:
All patients underwent a standardized three-step posterior sacral resection: (1) posterior exposure and anatomical localization of the sacral level; (2) curvilinear osteotomy using a broad-bladed osteotome with preservation of the presacral venous plexus; (3) neurovascular identification, hemostasis, and pelvic floor reconstruction (e.g., gluteus maximus flap).
Main Outcome Measures:
Total operative time, duration of sacral resection, intraoperative blood loss, R0 resection rate, postoperative complications (assessed via Neurogenic Bladder Symptom Score), and 5-year recurrence rates.
Results:
The median total operative time was 245 minutes (IQR, 210-285). The median sacral resection time was 40 minutes (IQR, 35-50), with a median blood loss of 150 mL (IQR, 100-250). All 47 patients (100%) achieved R0 resection. The 30-day and 90-day mortality were 0%. Major complications (Clavien-Dindo ≥ IIIb) were absent. Voiding dysfunction was common but transient: 7 patients (Neurogenic Bladder Symptom Score <20) recovered immediately; 15 (Neurogenic Bladder Symptom Score 20-40) recovered by 3 months; 20 (Neurogenic Bladder Symptom Score 40-60) recovered by 6 months; 5 (Neurogenic Bladder Symptom Score >60) recovered by 12 months. Superficial wound infection occurred in 8 patients (17.0%) and pelvic collection requiring drainage in 5 (10.6%). The median length of hospital stay was 19 days.
Limitations:
Single-region study with moderate sample size; lack of a control group for direct comparison with conventional approaches.
Conclusions:
This standardized three-step transperineal technique enables rapid, safe, and effective high sacrectomy with high R0 rates and acceptable morbidity, offering a promising option for patients with pelvic malignancies invading the high sacrum. See Video Abstract.
