One-stage total en bloc sacrectomy: a novel technique and report of 9 cases.

STUDY DESIGN: Nine patients with malignant sacral tumor underwent 1-stage total sacrectomy. The oncological and functional results are analyzed.

OBJECTIVE: To describe the surgical technique and evaluate the clinical outcome of the surgery.

SUMMARY OF BACKGROUND DATA: Very few reports specifically address total sacrectomy, and the 2-stage procedure combining the anterior and posterior approach is the most common method used for treatment.

METHODS: Between July 2007 and July 2010, 9 patients (7 males, 2 females; mean age, 33 yr; range, 13-59 yr) with malignant sacral tumor underwent 1-stage total sacrectomy the Peking University People's Hospital. The pathological diagnosis was chordoma in 3 patients, osteosarcoma in 2, chondrosarcoma in 2, malignant schwannoma in 1, and Ewing sarcoma in 1.

RESULTS: Oncological results: All 9 patients were followed-up for 11 to 35 months (mean follow-up time, 19.7 mo). Local recurrence was detected in the right ilium in the patient with Ewing sarcoma at 7 months after surgery, and locally in another patient with osteosarcoma at 3 months after surgery. The recurrent lesion in the right ilium was widely resected in the patient with Ewing sarcoma and no new lesion was found at the last follow-up, but this patient died of the lung metastases. The local recurrent lesion in the patient with osteosarcoma was treated with adjuvant chemotherapy and local radiation. Functional result: The S1 nerve root was cut bilaterally in 8 patients during surgery, resulting in the loss of foot plantar flexion. The 5 lumbar vertebrae were also resected with the sacrum in 1 patient, but the bilateral L5 nerve roots were preserved, and dorsiflexion was maintained in this patient.

CONCLUSION: Total sacrectomy can be performed successfully using a 1-stage combined anterior and posterior approach and is an important procedure for the treatment of primary malignant tumor involving the top portion of or the whole sacrum.