Quality of life and functional outcomes following pelvic exenteration and sacrectomy

Abstract

AimThe aim was to compare postoperative quality of life (QOL) between patients undergoing pelvic exenteration (PE) and pelvic exenteration with sacrectomy (PES), and to investigate the influence of high (L5-S2) vs low (≤ S3) sacrectomy on QOL and functional outcomes.Method Patients undergoing en bloc sacrectomy as part of a PE and PE alone from 2008 to 2015 were identified from a prospectively maintained database. ResultsOf the 344 patients identified, data were available for 116 patients who underwent PE alone and 140 patients who underwent PES. PES patients had significantly poorer physical component scores (P < 0.001) but not mental component scores (P = 0.17). Of the 140 PES patients, 55 were eligible and were invited to participate in a second functional survey, with 30 patients returning the study questionnaire. High sacrectomy patients, compared with low sacrectomy, had significantly worse lower limb motor function (P = 0.03) and poorer physical (P = 0.001) and mental health component scores (P = 0.02). No differences were found in sexual, bladder and bowel function between high and low sacrectomy patients.Conclusions Patients undergoing PES had worse physical component scores compared with PE alone, whereas high sacrectomy patients had significantly worse lower limb motor function and physical and mental component scores but comparable bowel, bladder and sexual functional outcomes compared with low sacrectomy patients.

Towards Standardisation of Technique for En Bloc Sacrectomy for Locally Advanced and Recurrent Rectal Cancer

“…In APR with flap reconstruction, complications, such as wound dehiscence, flap failure and perineal hernia, may have higher incidence when en bloc sacrectomy is additionally undertaken, with a higher transection level on the sacrum associated with higher perineal complication rates [ 38 , 39 , 40 ]. In fact, higher transections may be associated with higher all-cause morbidity, including physical function, pain, quality of life and bladder function [ 1 , 2 , 3 , 4 ], although other studies dispute this [ 13 , 18 , 41 ].…”

“…To achieve this where tumours invade or are adherent to the sacrum, en bloc sacrectomy at a radiologically predetermined level is the current standard of care. Sacral resection remains technically challenging, and the morbidity rises sequentially with higher levels of transection [ 1 , 2 , 3 , 4 ]. Major uncontrolled haemorrhage is a feared complication of sacrectomy, with 80% of patients shedding over a litre of blood and requiring at least one haemostatic agent [ 5 ].…”

“…The types of en bloc sacral resection vary and depend on the extent of tumour involvement and surgical expertise ( Figure 1 ), and a technical description of the operative steps involved has not yet been standardised. Sacrectomy may be categorised as high or low, based on the level of sacral transection in the axial plane, where low sacrectomy is below the foramen of the S2 nerve root, usually involving S3 or below [ 3 ]. Where tumours involve the midline of the sacrum but do not extend as laterally as the sacral foramina, a modified partial sacrectomy removing the anterior sacral cortex may be performed [ 7 , 8 ].…”

Functional outcomes following pelvic exenteration: results from a prospective cohort study

“…Patients who undergo pelvic exenteration with sacrectomy are usually known to have worse outcomes than pelvic exenteration alone due to the involvement of sacral nerves, affecting lower limb, urinary and bowel function, sexual health and overall quality of life [6,21,22]. High en bloc sacrectomy is associated with worse functional and quality of life outcomes in comparison with low en bloc sacrectomy [22,23]. However, most studies that examine postoperative outcomes of pelvic exenteration are focused on survival, postoperative complications, recurrence rates and patient-reported outcomes, and studies that objectively assess physical function are lacking.…”

Quality of life and functional outcomes following pelvic exenteration and sacrectomy, McCarthy et al.

“…The paper by McCarthy et al [4] in this issue is one of the first to use patient reported outcome measures following pelvic exenteration, with and without high or low sacrectomy. While there are inevitable limitations, this study is from a group with a strong track record in this field and describes highly relevant quality of life and functional outcomes in what is large and mature cohort given the rarity of this surgery.…”