Relationship between the level of sacral resection and short-term outcomes in patients undergoing total pelvic exenteration combined with sacral resection for rectal cancer

Background: This retrospective study aimed to elucidate the relationships between short-term outcomes following total pelvic exenteration combined with sacral resection (TPES) and operative techniques in patients with rectal cancer. Methods Data regarding sex, age, body mass index, neoadjuvant therapy, location of sacral resection (“Upper” or “Lower” relative to the level between the 3rd and 4th sacral segment), operative time, bleeding, and curability (R0/R1) were collected and compared to determine their association with complications exhibiting a Clavien–Dindo grade higher than III. Results The complication rate was significantly higher for recurrent cancers than for primary cancers (p = 0.007), and for “Upper” resection than for “Lower” resection (p = 0.078). Significant differences were observed when complication rates for “Upper” and “Lower” resection were compared between primary and recurrent cancers (p = 0.007). Conclusion In patients with recurrent rectal cancer, “Upper” sacral resection during TPES is associated with a high complication rate, highlighting the need for careful monitoring.