Systematic review of pelvic exenteration with en bloc sacrectomy for recurrent rectal adenocarcinoma – R0 resection predicts disease free survival

Background: The management of recurrent rectal cancer is challenging. At the present time pelvic exenteration with en bloc sacrectomy offers the only hope of lasting cure. Objective: The purpose of this study was to evaluate clinical outcome measures and complication rates following sacrectomy for recurrent rectal cancer. Data Sources: Search conducted on ‘Pub Med’ for English language articles relevant to sacrectomy for recurrent rectal cancer with no time limitations. Study Selection: Studies reported sacrectomy with survival data for recurrent rectal adenocarcinoma. Main outcome measure: Disease free survival following sacrectomy for recurrent rectal cancer. Results: A total of 220 recurrent rectal cancer patients were included from 7 studies, of which 160 were male and 60 were female. Overall median operative time was 717 (570-992) minutes and blood loss was 3.7 (1.7-6.2) litres. An R0 (>1mm resection margin) resection was achieved in 78% of patients. Disease free survival associated with R0 resection was 55% at a median follow up period of 33 (17-60) months; however, none of the patients with R1 (