Global Spine J 2014; 04(04): 273-278
DOI: 10.1055/s-0034-1375562
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Anterior-only Partial Sacrectomy for en bloc Resection of Locally Advanced Rectal Cancer

Hector Roldan1, Luis F. Perez-Orribo1, Julio M. Plata-Bello1, Antonio I. Martin-Malagon2, Victor M. Garcia-Marin1
  • 1Department of Neurosurgery, Hospital Universitario de Canarias, University of La Laguna, Tenerife, Spain
  • 2Department of Digestive Surgery, Hospital Universitario de Canarias, University of La Laguna, Tenerife, Spain
Further Information

Publication History

26 January 2014

17 March 2014

Publication Date:
28 April 2014 (eFirst)

Abstract

Study Design Case report.

Objective The usual procedure for partial sacrectomies in locally advanced rectal cancer combines a transabdominal and a posterior sacral route. The posterior approach is flawed with a high rate of complications, especially infections and wound-healing problems. Anterior-only approaches have indirectly been mentioned within long series of rectal cancer surgery. We describe a case of partial sacrectomy for en bloc resection of a locally advanced rectal cancer with invasion of the low sacrum through a combined transabdominal and perineal approach without any posterior incision.

Methods Through a midline laparotomy, the tumor was dissected and the sacral osteotomy was performed. Once the sacrum was mobile, the muscular attachments to its posterior wall were cut through the perineal approach. This latter route was also used to remove the whole specimen.

Results The postoperative period was uneventful in terms of infection and wound healing, but the patient developed right foot dorsiflexion paresis that completely disappeared in 1 month. Resection margins were negative. After a follow-up of 18 months, the patient has no local recurrence but presented lung and liver metastases.

Conclusion In cases of rectal cancer involving the low sacrum, the combination of a transabdominal and a perineal route to carry out the partial sacrectomy is a feasible approach that avoids changes of surgical positioning and the morbidity related to posterior incisions. This strategy should be considered when deciding on undertaking partial sacrectomy in locally advanced rectal cancer.