累及上骶骨的局部复发性直肠癌（LRRC）通常被认为是根治性手术的禁忌症。在 LRRC 的手术治疗中，经常进行骶骨切除术以确保清晰的切除边缘。尽管如此，由于潜在的术后并发症、激进性问题以及手术复杂性的增加，高位骶骨切除术的适应证仍然存在争议。此外，针对这一问题的综合研究明显缺乏。本研究旨在评估高位骶骨切除术治疗 LRRC 的可行性、安全性和手术预后。对 2003 年至 2014 年间所有需要同时行骶骨切除术但不包括第二骶椎下缘的 LRRC 患者进行回顾性分析。本研究纳入了 8 名中位年龄为 59 岁的患者。骶骨切除的近端切除线为 S1 椎体中央部（1 例）、S1 椎体下缘（6 例）、S2 椎体中央部（1 例）。八名患者中有五名实现了阴性切缘切除。中位手术时间为 922 分钟，中位手术失血量为 6,370 毫升。主要并发症包括盆腔脓肿（n = 5）、肠梗阻（n = 1）和肺静脉栓塞（n = 1），但术后均未出现致命性并发症。 5年局部无复发生存率和5年无远处转移生存率均为50%（4/8）。高位骶骨切除术对于LRRC患者实现负切缘是安全可行的。版权所有 © 2023 国际抗癌研究所（George J. Delinasios 博士），保留所有权利。

Locally recurrent rectal cancer (LRRC) involving the upper sacrum is generally considered a contraindication for curative surgery. In the surgical management of LRRC, sacrectomy is frequently performed to secure clear resection margins. Nonetheless, the indications for high sacrectomy remain controversial due to potential postoperative complications, questions about radicality, and the increased complexity of the operation. Furthermore, comprehensive studies addressing this issue are notably absent. This study aimed to assess the feasibility, safety, and surgical prognosis in high sacrectomy for LRRC.All patients with LRRC who required concomitant sacrectomy, but did not include the inferior margin of the second sacral vertebra, between 2003 and 2014, were reviewed retrospectively.Eight patients with a median age of 59 years were included in this study. The proximal resection line for sacral bone resection was the central part of the S1 vertebra in one patient, lower edge of the S1 vertebra in six patients, and central part of the S2 vertebra in one patient. Negative margin resection was achieved in five out of the eight patients. The median operative time was 922 min, and the median operative blood loss volume was 6,370 ml. Major complications included pelvic abscess (n=5), ileus (n=1), and pulmonary vein embolism (n=1), none of which proved fatal during the postoperative period. Both the 5-year local re-recurrence-free survival rate and the 5-year distant metastasis-free survival rate were 50% (4/8).High sacrectomy is safe and feasible to achieve negative margins in patients with LRRC.Copyright © 2023 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.