S1 Sacrectomy for Re-recurrent Rectal Most cancers: Our Expertise with Reconstruction Utilizing an Expandable Vertebral Physique Alternative System.
Dis Colon Rectum. 2018 Feb;61(2):261-265
Authors: Lee DJK, Wang KY, Sagar PM, Timothy J
INTRODUCTION: R0 resection is achieved by excessive sacrectomy for native recurrence of colorectal most cancers, however important charges of perioperative problems and long-term affected person morbidity are related to this process. On this report, we define our distinctive expertise of utilizing an expandable cage for vertebral physique reconstruction following S1 sacrectomy in a 66-year-old affected person with re-recurrent rectal most cancers. We purpose to spotlight a number of key steps, with a view to bettering postoperative outcomes.
TECHNIQUE: A midline laparotomy was carried out with the affected person in supine Lloyd-Davies place, demonstrating recurrence of tumor on the S1 vertebral physique. Subtotal vertebral physique excision of S1 with sparing of the posterior wall and ventral foramina was accomplished by utilizing an ultrasonic bone aspirator. Reconstruction was carried out utilizing an expandable corpectomy spacer system. The system was assembled and expanded in situ to optimally bridge the corpectomy. The system was secured into the L5 and S2 vertebrae by way of angled finish plate screws superiorly and inferiorly. Bone grafts have been positioned adjoining to the implant after this.
RESULTS: Complete working time was 266 minutes with 350?mL of intraoperative blood loss. There have been no fast postoperative problems. The affected person didn’t report any again ache on the time of discharge, and no neurological deficit was reported or recognized. Postoperative CT scan confirmed wonderful vertebral alignment and preservation of S1 peak.
CONCLUSION: We conclude that prime sacrectomy with an expandable steel cage is possible within the context of re-recurrent rectal most cancers when consideration is given to the tactic of osteotomy and vertebral physique substitute.
PMID: 29337783 [PubMed – indexed for MEDLINE]