J Korean Soc Coloproctol.  2010 Jun;26(3):197-203. 10.3393/jksc.2010.26.3.197.

Trans-Sacral Local Resection as a Posterior Approach

• Lee BH
• Park HC
• Lee HW
• An CN
• Um T
• Lim YA
• Kim BS
• Chang MY
• Kim SH
• Cho SW

• KMID: 2101516
• DOI: http://doi.org/10.3393/jksc.2010.26.3.197

Abstract

PURPOSE
Surgical removal for a mass in the pre-sacral space or mid rectum through a posterior approach is not frequent. We would like to present the technique of trans-sacral local resection as a posterior approach. We analyzed the follow up of patients who underwent surgery using the proposed technique.
METHODS
A total of 21 patients who had undergone a trans-sacral local resection with lower sacrectomy between January 1997 and December 2006 were enrolled in this study. The diagnoses were large epidermal cyst, gastrointestinal stromal tumor, high grade adenoma, and early cancers in the mid rectum. We analyzed the surgical complications and disease recurrences. The mean follow up for tumors of the rectum was 53+/-35 mo.
RESULTS
Epidural anesthesia was appropriate for all whole procedures. Among the 21 cases, there was one case of a rectocutaneous fistula as a postoperative complication (4.9%). In one case among the submucosal cancers, there was a systemic metastasis at 24 mo without local recurrence.
CONCLUSION
In our experience, a trans-sacral resection with a lower sacrectomy is a good option and provides a wide and direct surgical exposure for the removal of a pre-sacral or a mid-rectal mass. Good bowel preparation is mandatory.

Keyword

Local excision; Rectal cancer; Trans-sacral resection; Sacrectomy; Posterior approach

MeSH Terms

Adenoma
Anesthesia, Epidural
Epidermal Cyst
Fistula
Follow-Up Studies
Gastrointestinal Stromal Tumors
Humans
Neoplasm Metastasis
Postoperative Complications
Rectal Neoplasms
Rectum
Recurrence