Is total en bloc sacrectomy using a posterior-only approach feasible and safe for patients with malignant sacral tumors?

Abstract

OBJECT In this study the authors' aim was to describe their experience with total en bloc sacrectomy using a posterioronly approach and to assess the outcome of patients with malignant sacral tumors who underwent this procedure at their center. METHODS The authors identified and retrospectively reviewed the records of 10 patients with malignant sacral tumors who underwent a total en bloc sacrectomy via a single posterior approach at their center. The pathological diagnosis was chordoma in 4 patients, chondrosarcoma in 1, osteosarcoma in 1, malignant schwannoma in 1, malignant giant cell tumor in 1, and Ewing's sarcoma in 2. Radiological examination revealed that the tumor involved S1-5 in 7 patients, S1-4 in 1, S1-3 in 1, and S1-2 in 1. RESULTS All 10 patients were stable during the perioperative period. The mean surgery duration was 282 minutes (range 250-310 minutes). The median estimated blood loss was 2595 ml (range 1500-3200 ml). All patients were followed up for 13-29 months (mean 22 months). Two patients had a local recurrence. Two patients died of disease, 1 patient was alive with disease, and 7 patients were alive without evidence of disease. Among the 8 surviving patients, 6 were able to walk without assistive devices, and 2 were able to walk with crutches. The total complication rate was 40% (4 of 10). Wound complications (deep infection and wound healing problems) occurred in 3 patients, and a distal deep vein thrombosis occurred in 1 patient. CONCLUSIONS Total en bloc sacrectomy using a posterior-only approach is feasible and safe in selected patients and is an important procedure for the treatment of primary malignant tumor involving the entire sacrum or only the top portion.