Severe complications after intraoperative radiofrequency: Ablation of rectal cancer pelvic recurrence

Pelvic recurrence (PR) accounts for 5% to 45% in patients submitted to curative resection of rectal cancer and are usually unsuitable for radical excision as most of them are extraluminal. Patients with PR have short survival with poor quality of life even in the absence of distal metastases. We report a case of a 75 year-old male patient treated for PR with infiltration of the presacral and precoccicegeal tissue occurred 48 months after anterior resection of the rectum followed by chemo-radiotherapy. The patient was submitted to a new colonic resection and intraoperative radiofrequency ablation (RFA) of the residual pelvic cancer tissue. After the surgical treatment, the patient had relief of pelvic pain but he developed fever, urinary retention and sacral osteomyelitis. The symptoms improved with antibiotic therapy but the bladder did not recover its sensitivity and required permanent catheterization. Six months later the patient had not clinical and radiological signs of cancer recurrence but he developed leg ischemia secondary to popliteal artery occlusion and died of septic complications. RFA provides an innovative surgical tool for recurrent pelvic cancer but it should be reserved for patients who are unable to benefit from other treatment due to its considerable morbidity.