Complex Spine / Spine Oncology Fellow Northwell Health, Hoftstra University Hempstead, New York, United States
Introduction: Colorectal carcinoma is the fourth most common cause of death due to cancer, with 700,000 deaths per year. Non-operative management of locally recurrent gastrointestinal carcinoma features chemotherapy and radiation but provides only a 5-year survival rate of 5%, and progression-free rate of just 7%. Resection with negative margins followed by adjuvant therapy affords the greatest opportunity to increase patient survival. Invasion of the sacrum by a colorectal carcinoma is often treated with palliative radiation. In this study, we examined how partial or total sacrectomy utilized in locally recurrent gastrointestinal carcinoma patients with sacral invasion can affect local control and overall survival.
Methods: A retrospective study was conducted to identify all patients who underwent sacrectomy during surgical resection of locally recurrent gastrointestinal carcinoma at two comprehensive cancer centers between January 2005 and May 2022. Demographic, clinical, tumor-specific, operative characteristics, and outcome data were collected. The primary outcomes were local tumor recurrence and overall survival. Data is presented as counts and percentages.
Results: A total of twenty-one patients with a median age of 49 years (range: 30-76), including 10 (48%) male patients, underwent sacrectomy (3 total, 18 partial) for locally invasive gastrointestinal carcinoma. Pathology identified colorectal adenocarcinoma in 20 patients (95%) and squamous cell carcinoma of the anus in one patient (4.8%). En-bloc resection was achieved in 17 (81%) of patients. Median progression-free survival after sacrectomy was 10.4 months and median overall survival was 39.5 months.
Conclusion : When compared in current literature, en-bloc resection of locally recurrent gastrointestinal carcinoma affords the greatest improvement in overall survival, whereas palliative radiotherapy is associated with a median survival of 14 months. In this series, overall survival was 39.5 months after sacrectomy, although progression usually occurred in under a year. Such results suggest that a concurrent sacrectomy with en-bloc resection should be considered in patients with sacral invasion from locally recurrent gastrointestinal carcinoma.
