Bowel and bladder continence, wound healing, and functional outcomes in patients who underwent sacrectomy

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Object

Total or partial sacrectomy is a rare procedure in patients with locally invasive tumors involving the sacrum; it may be associated with functional loss, such as bowel and bladder dysfunction and gait abnormality. In this study the authors examined functional outcome following sacrectomy.

Methods

The authors reviewed the charts of 50 consecutive patients who had undergone sacrectomy between July 1993 and August 2002. There were 23 male and 27 female patients whose mean age was 46 years (range 13–86 years). Twelve patients with rectal cancer underwent a separate analysis. The patients without rectal cancer were divided into two groups: those who had undergone colostomy for bowel diversion (Group 1, six cases), and those who had not (Group 2, 32 cases).

In Group 1 patients the median hospital length of stay (LOS) was 48.5 days (the 25th% and 75th percentiles are 26 and 58, respectively), and in Group 2 patients the median LOS was 18.5 days (the 25th and 75th percentiles are 8 and 41, respectively; p = 0.14). In Group 2 (non—rectal cancer without colostomy), LOS was greater in patients in whom a myocutaneous flap was used compared with those in whom no flap was used (36 days compared with 8.5 days, respectively; p = 0.0012); in patients with bowel incontinence the median LOS was significantly longer than that in patients with bowel continence (39 days compared with 8 days, respectively; p = 0.0026). The incidence of bowel incontinence in Group 2 was closely related to the integrity of the S-3 nerve root (p = 0.05).

Conclusions

Awareness of the association between S-3 nerve root resection and bowel and bladder incontinence may help surgeons' decision-making process.

Article Information

Address reprint requests to: Ying Guo, M.D., Department of Palliative Care and Rehabilitation Medicine, Section of Physical Medicine and Rehabilitation, Unit 08, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030. email: yguo@mdanderson.org.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Bar graph depicting LOS in non—rectal cancer patients who had undergone colostomy (Group 2) compared with those in whom colostomy was not performed (Group 1). There was no significant difference (p = 0.1365).

  • View in gallery

    Bar graph. Comparison of the hospital LOS and wound healing days in Group 2 patients stratified by those who had undergone flap surgery (white bars) and those who had not (gray bars). Asterisk indicates statistical significance (p = 0.0012).

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    Bar graph. Comparison of the LOS and wound healing days in Group 2 patients with continent bowel (white bars) and incontinent bowel (gray bars). Asterisk indicates statistical significance (p = 0.003).

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    Bar graph showing the incidence of patients with incontinent bowel associated with a sacrificed S-3 nerve root (p = 0.05) in Group 2.

  • View in gallery

    Bar graph demonstrating that the incidence of ambulation (y axis [percentage of patients]) is not significantly different between patients with an intact bilateral S-1 nerve root and those with a bilateral S-1 nerve root not intact (p = 0.1456).

  • View in gallery

    Bar graph. The hospital LOS and wound healing days are not significantly different in patients with rectal cancer compared with those without rectal cancer (p = 0.16 and 0.27, respectively).

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