J.Jpn. Surg. Soc.. 119(5): 496-502, 2018

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Feature topic

TREATMENT STRATEGY FOR RECTAL CANCER INVADING THE SACRUM

Advanced primary rectal cancer generally involves anterior organ invasion, and the tumor usually invades the sacrum in special cases of poorly differentiated adenocarcinoma and anal fistula cancer. However, locally recurrent rectal cancer invades the sacrum posteriorly. Detailed knowledge of sacral topology and an operative strategy based on the degree of invasion are essential for the surgical treatment of patients with rectal cancer invading the sacrum. Abdominoperineal resection with sacral resection (APRS) and total pelvic exenteration with sacral resection (TPES) are performed for rectal cancer invading the sacrum. Low sacrectomy (at or below S3) with a presacral approach is curative and only involves minimally invasive extended surgery. The estimated cumulative 5-year survival rates after curative resection are 62.5% in primary rectal cancer and 28.3% in locally recurrent rectal cancer. Recurrent rectal cancer invading the sacrum has a relatively poor prognosis. Chemotherapy, radiotherapy, and heavy-particle radiotherapy are adjuvant therapies for sacral cortex invasion. Compared with other conventional surgical procedures, both APRS and TPES are recommended as being safer and having a higher curative rate if the appropriate indications are followed when selecting patients for them.

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