[Clinical value of presacral dissection technique in combined pelvic organ resection for locally advanced and locally recurrent rectal cancer].

Objective: o investigate the feasibility, safety, and short-term efficacy of the presacral enucleation technique in combined pelvic organ resection for locally advanced or locally recurrent rectal cancer. Methods: A descriptive case series study was conducted. Based on the Chinese database of patients undergoing combined pelvic organ resection for rectal cancer, clinical data were collected from 34 patients admitted to the Department of Colorectal and Anal Surgery, the Second Affiliated Hospital of Naval Medical University between December 1, 2024 and June 30, 2025. All patients were diagnosed with locally advanced or locally recurrent rectal cancer without extrapelvic metastasis, or with only oligometastasis, and underwent combined pelvic organ resection combined with presacral enucleation or sacrectomy. Among the patients, there were 21 males (61.8%) and 13 females (38.2%); the median age was 52 (31-72) years. There were 4 cases (11.8%) of locally advanced rectal cancer and 30 cases (88.2%) of locally recurrent rectal cancer. The surgical procedure of presacral enucleation in our center was summarized as "taking the lateral sacral vessels as the central axis, performing flanking encirclement followed by basal control." The main observational indicators included: (1) Surgical parameters: surgical resection scope, operative time, intraoperative blood loss, and tissue reconstruction; (2) Postoperative recovery: intestinal function recovery time, drainage tube removal time, and empty pelvic cavity healing time; (3) Postoperative complications, which were graded according to the international Clavien-Dindo classification system. Results: All patients successfully completed combined pelvic organ resection with presacral enucleation. The median operative time was 639 (205-960) min, the median intraoperative blood loss was 1 700 (200-4 500) ml, and the median intraoperative blood transfusion volume was 1 400 (400-3 200) ml. R0 resection was achieved in 30 cases (88.2%), and R1 resection in 4 cases (11.8%). There were 3 cases (8.8%) of simple presacral enucleation, 1 case (2.9%) of presacral enucleation combined with coccygectomy, 16 cases (47.1%) of presacral enucleation combined with S4-5 resection and coccygectomy, 7 cases (20.6%) of presacral enucleation combined with S3-5 resection and coccygectomy, and 7 cases (20.6%) of presacral enucleation combined with S3-5 resection, coccygectomy, and S3 nerve root resection. Surgery was completed in the lithotomy position in 28 cases (82.4%), and in the combined lithotomy and prone jackknife position in 6 cases (17.6%). The median intestinal function recovery time was 3.8 (2.0-8.0) days, the median drainage tube removal time was 31.7 (19.0-48.0) days, and the median empty pelvic cavity healing time was 33.4 (24.0-63.0) days. There were 11 cases (32.4%) of grade I-II complications and 8 cases (23.5%) of grade IIIa-IV complications. The median follow-up duration was 8.5(6.0-13.0) months. No death occurred within 90 days after the operation. During the follow-up period, 2 patients (5.9%) died due to rapid progression of distant tumor metastasis. Conclusion: The presacral enucleation technique is safe and feasible in combined pelvic organ resection for locally advanced or locally recurrent rectal cancer.