Abstract
Introduction
Chordoma is the most frequent primary spine tumor, with majority involved in the sacrococcygeal region. Because chordoma is rare, slowly growing, and locally aggressive, it is difficult to evaluate the effectiveness of treatment protocols and prediction of outcome. En bloc resection of primary sacral tumors is the primary modality. Rates of local recurrence and survival were dependent on negative surgical margins.
Methods
To assess our series of 36 sacral chordoma surgeries, emphasizing overall surgical and oncologic outcomes. Patients underwent sacral resections for chordoma at our institution between 1995 and 2011. Medical records of all patients were reviewed, including 36 patients who underwent primary en bloc sacral resections, either total and high sacrectomies by a combined anterior and posterior approach, or posterior-only en bloc midsacral resection.
Results
Sacral amputation was defined by the level: L5 (9 cases, 26%), S1 (8 cases, 23%), S2 (13 cases, 27%), and S3 (5 cases, 14%). Extent of resection was en bloc in 34 cases and intralesional in 2 cases. Flap reconstruction was performed in 29 cases (85%), with gluteal in 20 cases (69%) and VRAM in 9 cases (31%). All patients were followed-up 87 ± 54 months (range: 22–215 months) after surgery. Twenty-two patients have disease-free survival till date. Fourteen of the 34 patients who underwent en bloc resection had recurrence: 7 patients died 70 months after surgery and the other 7 survived 114 months after surgery. Among them, 5 cases had local sacral and iliac recurrence, while 10 cases had distal metastasis, such as liver, lung, and muscular skeleton.
Conclusion
En bloc sacral resections/reconstructions in patients with chordoma increase survival and decrease tumor recurrence.