Treating recurrent rectal caner that invades the pelvic area: major surgical options

This article reviewed several clinical studies where radical surgical procedures have been used to treat rectal cancer that has invaded the area of the pelvis. 

The sacrum bone is the lowest part of the spine which sits between the hip bones.  It is made up of 5 vertebrae which are separate bones during childhood but fuse in late teen years to form a triangular bone. When rectal cancer invades through the walls of the rectum and into the pelvic area (locally invasive), the sacrum is often involved.  However, surgery to remove these tumors is not common practice, since it may involve removing part or all of the sacrum. Removal of the upper part of the sacrum can result in lower limb disability and the patient needing to use a walking aid. If the entire sacrum is removed the lumber spine would have to be supported to allow the patient to bear weight on the lower limbs, this usually involves insertion of metal rods. This and other radical surgical techniques such as removing parts of the pelvis (hemipelvectomy) and lower limbs, are considered as optional procedures for the treatment of locally recurrent rectal cancer that involves the pelvis.

This article looks at 44 clinical studies dealing with patient outcome and survival rates following radical procedures to remove locally invasive recurrent rectal cancer. One of the studies discussed in this report shows that 30% of the patients who had complete surgical removal of locally invasive rectal cancer survived for 5 years post-surgery. Survival rate was 25% in patients who received sacrectomy surgery (Sacrum removal) following a recurrence of the cancer. This is a large increase in the 5-year survival rate when compared to those treated with radiotherapy alone (3%). Additionally the paper discusses survival rates of patients who have been treated surgically with a hemipelvectomy. 5 year survival rates in these patients ranged from 18-95% with a good percentage being able to walk with the aid of a prosthesis.

In summary, this paper discusses radical surgical procedures that may not always be discussed with patients. This may give patients with what they consider as inoperable cancer to have additional treatment options. If patients and surgeons are willing to consider these relatively aggressive surgical techniques, higher survival rates can be achieved, compared to radiotherapy per se.

Patients must however consider that these radical surgical techniques do have high morbidity rates (complications and sickness) associated with them. These morbidity rates are associated with post-operative wound infection following surgery and blood loss during surgery.