Oncological and Functional Outcome Following Sacrectomy for Sacral Tumors

Introduction: There is a relative paucity of data regarding functional and oncologic outcomes for patients undergoing sacrectomy for sacral tumors.

Materials and Methods: The clinical records of twenty-four patients undergoing sacrectomy were evaluated retrospectively. Variables analyzed included onset, treatment, length of hospital stay, local and metastatic recurrence rates, survival, use of adjuvants, functional outcome measures including ambulatory ability and bowel and bladder control, and complications. Chi-square test, ANOVA, and Kruskall-Wallis test were used to analyze data.

Results: Twenty-four patients underwent sacrectomy at one institution from 1985 until 2001. Histologic diagnoses included chordoma, colorectal adenocarcinoma, chondrosarcoma, malignant fibrous histiocytoma, teratoma, and ganglioneuroma. Average age at diagnosis was 58.6 years. There were 14 males and 10 females. Mean follow-up was 48 months. Overall local recurrence was rate was 58.3 percent. Mean time to first, second, third and fourth recurrence was 26.2 months, 40 months, 51.7 months, and 62.3 months, respectively. Mean time to metastasis was 45 months. Twenty-five percent of patients were clinically diseasefree at a mean follow-up of 65.5 months. Twenty-one percent of patients died from local recurrence and metastasis. Seventeen percent of patients had normal bowel and bladder control post-operatively. Thirty-eight percent were able to ambulate without assistive devices. Fifty percent of patients had wound complications and eight percent had a deep vein thrombosis. There was one perioperative death related to the index procedure and one perioperative death related to a subsequent surgery for local recurrence. Neither negative margins at time of initial tumor resection nor adjuvant radiotherapy had a statistically significant impact on survival or local recurrence, although there was a trend towards decreased local recurrence with negative margins (p=0.069). More proximal levels of resection were associated with significantly worse bowel (p<0 .001) and bladder (p<0.01) control a trend towards increased blood loss (p="0.08)." Complications were frequent significantly higher in number with increasing tumor size at presentation (p<0.005).

Conclusions: In this series, local recurrence was frequent and metastases occurred late. Most patients with multiple recurrences developed distant disease. Adequate surgery for these tumors results in major functional impairment and significant perioperative complications. Negative surgical margins did not result in significantly improved oncologic outcomes. Adjuvant radiotherapy did not improve survival or rate of local recurrence. Improved functional outcomes with respect to bowel and bladder control, but not ambulatory status, were observed with more distal levels of resection.