High subcortical sacrectomy: a novel approach to facilitate complete resection of locally advanced and recurrent XXXX with high (S1-S2) sacral extension.

@entity5 @entity1 @entity260
AIM: R0 resection of locally advanced or recurrent @entity5 is the key determinant of outcome. Disease extension high on the sacrum has been considered a contraindication to surgery because of associated morbidity and difficulty in achieving complete pathological resection. Total sacrectomy has a high morbidity with poor function. METHOD: We describe a novel technique of high subcortical sacrectomy (HiSS) to facilitate complete resection of disease extending to the upper sacrum at S1 and S2 to avoid high or total sacrectomy or a nonoperative approach to management. Details of @entity1 demographics, radiology, operative details, postoperative histology, length of hospital stay and complications were entered into a prospectively maintained electronic @entity1 database. All @entity1 had had preoperative chemoradiotherapy. RESULTS: During 2013-2014, five @entity1 , including three with advanced primary @entity5 and two with recurrent @entity5 , underwent excision using this approach. All @entity1 had an R0 resection. Four @entity1 had a minor @entity260 (Clavien-Dindo Grades I and II) and one had a major complication (Clavien-Dindo Grade IIIb). There was no mortality at 90  days, and four @entity1 were disease free at a median of 18  months. CONCLUSION: @entity1 with locally advanced and recurrent @entity5 involving the upper sacrum may be rendered suitable for potentially curative radical resection with a modified approach to sacral resection. This pilot series suggests that this novel technique results in a high rate of complete pathological resection with acceptable morbidity in @entity1 for whom the alternatives would have been an incomplete resection, a total sacrectomy or nonoperative management.
