Presacral venous bleeding during mobilization in rectal cancer

Abstract

AIMTo analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer.METHODSA review of the databases MEDLINE® and Embase™ was conducted, and relevant scientific articles published between January 1960 and June 2016 were examined. The anatomy of the sacrum and its venous plexus, as well as the factors that influence bleeding, the causes of this complication, and its surgical management were defined.RESULTSThis is a review of 58 published articles on presacral venous plexus injury during the mobilization of the rectum and on techniques used to treat presacral venous bleeding. Due to the lack of cases published in the literature, there is no consensus on which is the best technique to use if there is presacral bleeding during mobilization in surgery for rectal cancer. This review may provide a tool to help surgeons make decisions regarding how to resolve this serious complication.CONCLUSIONA series of alternative treatments are described; however, a conventional systematic review in which optimal treatment is identified could not be performed because few cases were analyzed in most publications.

A novel transperineal approach for surgical resection of presacral tumors with an arc-shaped incision in front of the apex of the coccyx (with video)

“…Massive presacral hemorrhage caused by presacral vascular injury is a serious and potentially life-threatening complication of rectal and presacral surgery [ 8 , 9 ]. Our surgical approach demonstrated significant advantages with regard to hemostasis.…”

Post-Surgical Imaging Assessment in Rectal Cancer: Normal Findings and Complications

“…The overall risk is around 6%, and in 1% of cases it may manifest as massive hemorrhage and hemodynamic instability [ 63 , 64 ]. During surgery, a presacral fascia injury or avulsion of the rectosacral fascia could damage the presacral and basivertebral veins, causing bleeding that is difficult to manage with conventional hemostatic maneuvers [ 65 ]. Presacral venous plexus damage occurs more often in patients with advanced tumors or in the case of “hostile pelvis”, caused by radiotherapy [ 2 ].…”

Management and Morbidity of Major Pelvic Hemorrhage in Complex Abdominopelvic Surgery

“…Surgeons may encounter some severe intraoperative complications due to deep and narrow anatomical constraints of the pelvis during CAPS. Major pelvic hemorrhage (MPH) is one of the most challenging complications of CAPS with an incidence of 9% [2]. It may occur inadvertently during blunt or sharp dissection in the pelvis [3, 4].…”

“…Proper management of the pelvic hemorrhage is crucial to prevent fatal outcomes. The bleeding control techniques and outcomes of patients having MPH during CAPS were described in case reports or series only [2, 5]. Definition of risks and management strategies for MPH during CAPS in large cohorts may provide valuable information to avoid further complications and improve final outcomes in future patients.…”