Abdominal sacral resection of locally recurrent XXXX .

@entity1 @entity30798 @entity39 @entity5 @entity1695 @entity29 @entity188 @entity358 @entity158 @entity204 @entity420 @entity1930
Local recurrence of @entity5 develops in the posterior bony pelvis as an isolated event in about half of the @entity1 with recurrence. Although radiation can palliate sacral @entity158 , the disease is usually progressive and is rarely amenable to conventional resection. We have adapted a surgical technique usually used for primary @entity5 , which permits a complete en bloc excision of recurrent @entity5 in most instances. This approach consists of a laparotomy with pelvic dissection and mobilization of structures to be resected. The @entity1 is repositioned prone and the posterior pelvis (sacrum and side walls) is then resected with preservation of appropriate nerve roots of the @entity1930 . Reconstruction is done with muscle and skin flaps. We have done 21 such procedures, of which, 11 were for pelvic recurrence of @entity420 . Seven @entity1 had resections for cure and four had palliative resections of fungating or infected @entity5 . All but one @entity1 was postabdominal perineal resection and nine @entity1 had been irradiated (3000-9000 rads). Two @entity1 had received up to 9000 rads in separate courses (external beam in one and interstitial radiation in the other). The posterior extent of resection was @entity30798 to 5 in six @entity1 ; S3 to 5 in three @entity1 , and S4-5 in two @entity1 . Anterior exenteration was performed in three @entity1 and three @entity1 had additional resection of other organs. In the curative resection group, three @entity1 are living free of disease at six, ten, and 52 months, and one @entity1 was NED at 60 months, but has again had @entity5 recurrance and is living with disease at 65 months. One @entity1 died of disease at 13 months and one @entity1 died of a @entity358 following resection for @entity1695 at five months. One @entity204 occurred from a cerebrovascular accident at 52 days. In the palliative resection group, three @entity1 survived with relief of local @entity5 symptoms four, eight, and 12 months. One @entity1 who had received a total of 9000 rads developed @entity39 , @entity29 and died 60 days after resection. Although this is a small series, it suggests that abdominal sacral resection of locally advanced @entity5 is feasible and may provide good palliation in most and possible cure in some @entity1 who develop recurrence after primary resection of @entity188 .
