{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T21:30:25Z","timestamp":1790803825111,"version":"4.1.0"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Management of locally invasive colorectal carcinoma at any stage currently involves surgical excision followed by chemoradiotherapy; however, the prognosis is poor, with a 5-year overall survival (OS) of only 5%. Failure to achieve gross-total resection is associated with poorer OS, and patients with residual tumor postresection (R1 or R2 resection) have a median OS of 7 months compared with 23 months in those who undergo resection with negative margins (R0 resection). For tumors that have invaded the sacrum, sacrectomy becomes necessary to achieve R0 resection. The objective of this study was to provide a descriptive multicenter account of resection for locally invasive colorectal carcinoma with sacral invasion, focusing on the association of tumor morphometry with surgical planning and perioperative outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Demographic, comorbidity, clinical, tumor-specific, operative characteristic, and outcome data were collected on all patients who underwent resection of colorectal carcinoma with concurrent sacral resection between January 2005 and May 2022. Patients were grouped into those having undergone surgery for purely palliative intent, or those with resection with attempt at local control and dichotomized into level of osteotomy (either proximal or distal to the S2\u20133 level).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Twenty-two patients (median age 50.5 [IQR 43.3\u201360.0] years, 54.5% female) underwent sacrectomy for colorectal carcinoma. Operative records indicated intent for local control in 14 patients and palliative in the remaining 8 patients. Palliative surgical intent was based primarily on the presence of distant metastases. There was no significant difference in median local progression-free survival between patients undergoing osteotomy proximal to the S2\u20133 level and those undergoing osteotomy distal to the S2\u20133 level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>En bloc resection is believed to offer the best local control in patients with locally invasive colorectal carcinoma. The present descriptive series highlights outcomes of en bloc resection with partial or full sacrectomy in patients with tumors showing local extension into the sacrum. Complications are common, most often in the form of wound dehiscence or infection, and many patients require placement in a rehabilitation or intermediate-care facility upon discharge. However, for those with stage III (locally aggressive) disease, median OS exceeds 16 years, suggesting that such aggressive management with en bloc resection may be warranted in properly selected patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.10.spine24391","type":"journal-article","created":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T21:30:35Z","timestamp":1741383035000},"page":"598-604","source":"Crossref","is-referenced-by-count":3,"title":["Outcomes after en bloc resection with sacrectomy of advanced colorectal carcinomas that invade the sacrum: a multiinstitutional descriptive series"],"prefix":"10.3171","volume":"42","author":[{"given":"Thomas A.","family":"Pieters","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Zucker School of Medicine at Hofstra\/Northwell, Great Neck, New York;"},{"name":"Department of Neurosurgery, University of Massachusetts, Worcester, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.","family":"Hersh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aladine A.","family":"Elsamadicy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zach","family":"Pennington","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle","family":"Santangelo","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Rochester, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salem","family":"Najjar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zucker School of Medicine at Hofstra\/Northwell, Great Neck, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethany","family":"Hung","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roee","family":"Ber","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zucker School of Medicine at Hofstra\/Northwell, Great Neck, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chady","family":"Atallah","sequence":"additional","affiliation":[{"name":"Department of Surgery, New York University, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Efron","sequence":"additional","affiliation":[{"name":"Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Gearhart","sequence":"additional","affiliation":[{"name":"Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bashar","family":"Safar","sequence":"additional","affiliation":[{"name":"Department of Surgery, New York University, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Paul","family":"Wolinsky","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Sciubba","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zucker School of Medicine at Hofstra\/Northwell, Great Neck, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-fu Larry","family":"Lo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zucker School of Medicine at Hofstra\/Northwell, Great Neck, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Int J Mol Sci","first-page":"197","article-title":"Colorectal carcinoma: a general overview and future perspectives in colorectal cancer","volume":"18","author":"M\u00e1rmol I","year":"2017","unstructured":"M\u00e1rmol I, S\u00e1nchez-de-Diego C, Pradilla Dieste A, Cerrada E, Rodriguez Yoldi MJ. Colorectal carcinoma: a general overview and future perspectives in colorectal cancer. Int J Mol Sci. 2017;18(1):197."},{"key":"b2","series-title":"Crit Rev Oncol Hematol","first-page":"20","article-title":"Early colorectal cancer: diagnosis, treatment and survivorship care","volume":"136","author":"Buccafusca G","year":"2019","unstructured":"Buccafusca G, Proserpio I, Tralongo AC, Rametta Giuliano S, Tralongo P. Early colorectal cancer: diagnosis, treatment and survivorship care. Crit Rev Oncol Hematol. 2019;136:20\u201330."},{"issue":"3","key":"b3","series-title":"Dis Colon Rectum","first-page":"346","article-title":"Systematic review of pelvic exenteration with en bloc sacrectomy for recurrent rectal adenocarcinoma: R0 resection predicts disease-free survival","volume":"60","author":"Sasikumar A","year":"2017","unstructured":"Sasikumar A, Bhan C, Jenkins JT, Antoniou A, Murphy J. Systematic review of pelvic exenteration with en bloc sacrectomy for recurrent rectal adenocarcinoma: R0 resection predicts disease-free survival. Dis Colon Rectum. 2017;60(3):346\u2013352."},{"issue":"2","key":"b4","series-title":"Int J Radiat Oncol Biol Phys","first-page":"427","article-title":"Treatment of locally recurrent rectal carcinoma\u2014results and prognostic factors","volume":"40","author":"Wong CS","year":"1998","unstructured":"Wong CS, Cummings BJ, Brierley JD,  Treatment of locally recurrent rectal carcinoma\u2014results and prognostic factors. Int J Radiat Oncol Biol Phys. 1998;40(2):427\u2013435."},{"issue":"5","key":"b5","series-title":"Dis Colon Rectum","first-page":"929","article-title":"Surgery for locally recurrent rectal cancer","volume":"48","author":"Boyle KM","year":"2005","unstructured":"Boyle KM, Sagar PM, Chalmers AG, Sebag-Montefiore D, Cairns A, Eardley I. Surgery for locally recurrent rectal cancer. 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Am J Surg. 1992;163(4):370\u2013374."},{"issue":"3","key":"b12","series-title":"J Surg Oncol","first-page":"538","article-title":"Positive circumferential resection margins following locally advanced colon cancer surgery: risk factors and survival impact","volume":"121","author":"Goffredo P","year":"2020","unstructured":"Goffredo P, Zhou P, Ginader T,  Positive circumferential resection margins following locally advanced colon cancer surgery: risk factors and survival impact. J Surg Oncol. 2020;121(3):538\u2013546."},{"issue":"12","key":"b13","series-title":"Eur Spine J","first-page":"3925","article-title":"Residual neurological function after sacral root resection during en-bloc sacrectomy: a systematic review","volume":"25","author":"Zoccali C","year":"2016","unstructured":"Zoccali C, Skoch J, Patel AS, Walter CM, Maykowski P, Baaj AA. Residual neurological function after sacral root resection during en-bloc sacrectomy: a systematic review. 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World J Gastrointest Surg. 2016;8(12):770\u2013778."},{"issue":"2","key":"b20","series-title":"J Surg Oncol","first-page":"105","article-title":"High sacrectomy for locally recurrent rectal cancer: can long-term survival be achieved","volume":"103","author":"Dozois EJ","year":"2011","unstructured":"Dozois EJ, Privitera A, Holubar SD,  High sacrectomy for locally recurrent rectal cancer: can long-term survival be achieved? J Surg Oncol. 2011;103(2):105\u2013109."},{"issue":"3","key":"b21","series-title":"J Orthop Sci","first-page":"286","article-title":"Extent and contraindications for sacral amputation in patients with recurrent rectal cancer: a systematic literature review","volume":"16","author":"Kido A","year":"2011","unstructured":"Kido A, Koyama F, Akahane M,  Extent and contraindications for sacral amputation in patients with recurrent rectal cancer: a systematic literature review. J Orthop Sci. 2011;16(3):286\u2013290."},{"issue":"4","key":"b22","series-title":"Br J Surg","first-page":"484","article-title":"Influence of the level of sacrectomy on survival in patients with locally advanced and recurrent rectal cancer","volume":"106","author":"Lau YC","year":"2019","unstructured":"Lau YC, Jongerius K, Wakeman C,  Influence of the level of sacrectomy on survival in patients with locally advanced and recurrent rectal cancer. Br J Surg. 2019;106(4):484\u2013490."},{"issue":"11","key":"b23","series-title":"Spine J","first-page":"1908","article-title":"Sacrectomy for sacral tumors: perioperative outcomes in a large-volume comprehensive cancer center","volume":"21","author":"Feghali J","year":"2021","unstructured":"Feghali J, Pennington Z, Hung B,  Sacrectomy for sacral tumors: perioperative outcomes in a large-volume comprehensive cancer center. 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Crit Rev Oncol Hematol. 2019;136:20\u201330."},{"issue":"3","key":"b3","series-title":"Dis Colon Rectum","first-page":"346","article-title":"Systematic review of pelvic exenteration with en bloc sacrectomy for recurrent rectal adenocarcinoma: R0 resection predicts disease-free survival","volume":"60","author":"Sasikumar A","year":"2017","unstructured":"Sasikumar A, Bhan C, Jenkins JT, Antoniou A, Murphy J. Systematic review of pelvic exenteration with en bloc sacrectomy for recurrent rectal adenocarcinoma: R0 resection predicts disease-free survival. Dis Colon Rectum. 2017;60(3):346\u2013352."},{"issue":"2","key":"b4","series-title":"Int J Radiat Oncol Biol Phys","first-page":"427","article-title":"Treatment of locally recurrent rectal carcinoma\u2014results and prognostic factors","volume":"40","author":"Wong CS","year":"1998","unstructured":"Wong CS, Cummings BJ, Brierley JD,  Treatment of locally recurrent rectal carcinoma\u2014results and prognostic factors. 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J Surg Oncol. 2020;121(3):538\u2013546."},{"issue":"12","key":"b13","series-title":"Eur Spine J","first-page":"3925","article-title":"Residual neurological function after sacral root resection during en-bloc sacrectomy: a systematic review","volume":"25","author":"Zoccali C","year":"2016","unstructured":"Zoccali C, Skoch J, Patel AS, Walter CM, Maykowski P, Baaj AA. Residual neurological function after sacral root resection during en-bloc sacrectomy: a systematic review. Eur Spine J. 2016;25(12):3925\u20133931."},{"issue":"8","key":"b14","series-title":"Dis Colon Rectum","first-page":"1099","article-title":"Sacral resection for recurrent rectal cancer: analysis of morbidity and treatment results","volume":"49","author":"Melton GB","year":"2006","unstructured":"Melton GB, Paty PB, Boland PJ,  Sacral resection for recurrent rectal cancer: analysis of morbidity and treatment results. 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Eur J Surg Oncol. 2019;45(10):1787\u20131795."},{"issue":"1","key":"b17","series-title":"Ann Oncol","first-page":"186","article-title":"Correlation of progression-free and post-progression survival with overall survival in advanced colorectal cancer","volume":"24","author":"Petrelli F","year":"2013","unstructured":"Petrelli F, Barni S. Correlation of progression-free and post-progression survival with overall survival in advanced colorectal cancer. Ann Oncol. 2013;24(1):186\u2013192."},{"issue":"1","key":"b18","series-title":"J Res Med Sci","first-page":"14","article-title":"Does primary tumor resection contribute to overall survival in unresectable synchronous metastatic colorectal cancer","volume":"25","author":"Ergun Y","year":"2020","unstructured":"Ergun Y, Bal O, Dogan M,  Does primary tumor resection contribute to overall survival in unresectable synchronous metastatic colorectal cancer? J Res Med Sci. 2020;25(1):14."},{"issue":"12","key":"b19","series-title":"World J Gastrointest Surg","first-page":"770","article-title":"Abdominosacral resection for locally recurring rectal cancer","volume":"8","author":"Belli F","year":"2016","unstructured":"Belli F, Gronchi A, Corbellini C, Milione M, Leo E. Abdominosacral resection for locally recurring rectal cancer. World J Gastrointest Surg. 2016;8(12):770\u2013778."},{"issue":"2","key":"b20","series-title":"J Surg Oncol","first-page":"105","article-title":"High sacrectomy for locally recurrent rectal cancer: can long-term survival be achieved","volume":"103","author":"Dozois EJ","year":"2011","unstructured":"Dozois EJ, Privitera A, Holubar SD,  High sacrectomy for locally recurrent rectal cancer: can long-term survival be achieved? 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