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

Abstract：

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.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Guo W,Tang X,Zang J,Ji T

doi

10.1097/BRS.0b013e31828b7045

subject

Has Abstract

pub_date

2013-05-01 00:00:00

pages

E626-31

issue

eissn

0362-2436

issn

1528-1159

journal_volume

pub_type

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