Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2016; 8(12): 770-778
Published online Dec 27, 2016. doi: 10.4240/wjgs.v8.i12.770
Abdominosacral resection for locally recurring rectal cancer
Filiberto Belli, Alessandro Gronchi, Carlo Corbellini, Massimo Milione, Ermanno Leo
Filiberto Belli, Carlo Corbellini, Ermanno Leo, Colorectal Surgery Unit, National Cancer Institute, 20133 Milan, Italy
Alessandro Gronchi, Sarcoma-Melanoma Surgery Unit, National Cancer Institute, 20133 Milan, Italy
Massimo Milione, Department of Pathology, National Cancer Institute, 20133 Milan, Italy
Author contributions: Belli F, Gronchi A and Corbellini C contributed to study conception, data interpretation and writing of article; Corbellini C and Milione M contributed to data acquisition; Leo E contributed to final approval of the version of the article to be published.
Institutional review board statement: This observation study has received approval from the Ethical Board of National Cancer Institute of Milan.
Informed consent statement: Written informed consent was obtained from all patients when possible.
Conflict-of-interest statement: None of the authors have conflict of interest or founding sources to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Filiberto Belli, MD, Colorectal Surgery Unit, National Cancer Institute, Via Venezian 1, 20133 Milan, Italy. filiberto.belli@istitutotumori.mi.it
Telephone: +39-02-23902957 Fax: +39-02-23902957
Received: June 25, 2016
Peer-review started: June 28, 2016
First decision: August 5, 2016
Revised: September 27, 2016
Accepted: October 22, 2016
Article in press: October 24, 2016
Published online: December 27, 2016

To investigate feasibility and outcome of abdominal-sacral resection for treatment of locally recurrent rectal adenocarcinoma.


A population of patients who underwent an abdominal-sacral resection for posterior recurrent adenocarcinoma of the rectum at the National Cancer Institute of Milano, between 2005 and 2013, is considered. Retrospectively collected data includes patient characteristics, treatment and pathology details regarding the primary and the recurrent rectal tumor surgical resection. A clinical and instrumental follow-up was performed. Surgical and oncological outcome were investigated. Furthermore an analytical review of literature was conducted in order to compare our case series with other reported experiences.


At the time of abdomino-sacral resection, the mean age of patients was 55 (range, 38-64). The median operating time was 380 min (range, 270-480). Sacral resection was performed at S2/S3 level in 3 patients, S3/S4 in 3 patients and S4/S5 in 4 patients. The median operating time was 380 ± 58 min. Mean intraoperative blood loss was 1750 mL (range, 200-680). The median hospital stay was 22 d. Overall morbidity was 80%, mainly type II complication according to the Clavien-Dindo classification. Microscopically negative margins (R0) is obtained in all patients. Overall 5-year survival after first surgical procedure is 60%, with a median survival from the first surgery of 88 ± 56 mo. The most common site of re-recurrence was intrapelvic.


Sacral resection represents a feasible approach to posterior rectal cancer recurrence without evidence of distant spreading. An accurate staging is essential for planning the best therapy.

Keywords: Rectal cancer recurrence, Local recurrence, Sacral resection, Abdominosacral resection, Recurrent rectal cancer

Core tip: During the last years, great efforts have been invested by many authors to contribute in treatment of rectal cancer recurrence without evidence of distant spreading. The most difficult surgical problem is to perform an affective radical R0 salvage resection. However, with the introduction of sacral resection, consistent improvements have been achieved in recent years, particularly when local tumor relapse occurs in the posterior part of the pelvis, from the presacral to the retrovescical spaces. However, abdominosacral resection is a complex surgical procedure affected by several postoperative complications. For this reason, these patients should be treated into dedicated and specialized institutions.