Improving Surgical Outcomes in Pelvic Exenteration Surgery: Comparison of Prone Sacrectomy with Anterior Cortical Sacrectomy Techniques

To assess the effect of changing our sacrectomy approach from prone to anterior on surgical and oncological outcomes. In patients with advanced pelvic malignancy involving the sacrum, pelvic exenteration (PE) with en-bloc sacrectomy is the only potential curative option but morbidity is high. Over time sacrectomy techniques have evolved from prone sacrectomy (PS) to abdominolithotomy sacrectomy (ALS, S3) and high anterior cortical sacrectomy (HACS, >S3) to optimize surgical outcomes. A retrospective, single institution analysis of prospectively collected data for patients undergoing PE with en-bloc sacrectomy between 1994 and 2021 was performed. 363 patients were identified and divided into PS (n=77, 21.2%), ALS (n=247, 68.0%) and HACS (n=39, 10.7%). Indications were: locally advanced (n=92) or recurrent (n=177) rectal cancer, primary other (n=31), recurrent other (n=60) and benign disease (n=3). PS resulted in longer operating time (P