Skip to main content

Advertisement

SpringerLink
Log in

Surgical classification of different types of en bloc resection for primary malignant sacral tumors

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

The purpose of the study was to develop a surgical classification system for primary malignant sacral tumors.

Methods

The sacrum is divided into three regions 1, 2 and 3 by the S1–S2 and S2–S3 junctions. En bloc resections were classified into five types: type I involves regions 1, or 1 and 2, or regions 1, 2 and 3, type II involves regions 2 and 3, and type III involves only region 3. Type IV includes sagittal hemisacrectomy and resection of a portion of the adjacent ilium. Type V includes the sacrum and the fifth lumbar vertebra. 117 patient cases (68 females and 49 males) were reviewed.

Results

There were two perioperative deaths. Of the 35 patients who should have undergone type I resection, local recurrence (LR) occurred in four of the 14 patients who underwent type I resection with free margins without tumor rupture. The other 21 patients underwent piecemeal resection, and LR occurred in 15 (P = 0.013). 35 patients underwent type II resection. Free margin without tumor rupture was accomplished in 26 and LR occurred in 6. Tumor rupture (TR) occurred in the other 9 and LR occurred in seven (Yates’ P = 0.012). All 33 patients underwent type III resection with free margins without tumor rupture. LR occurred in five. 11 patients had type IV resection. Free margin without tumor rupture was accomplished in seven and LR occurred in three. TR occurred in the other four, and LR occurred in two (Yates’ P = 0.689). One patient underwent type V resection with free margin without tumor rupture and LR occurred. Postoperatively, less than 1/3 needed long-term urethral catheterization. No patients received colostomy for postoperative fecal incontinence. All the patients were able to ambulate.

Conclusion

Our classification system and the corresponding surgical approaches are helpful in dealing with primary malignant sacral tumors. Better oncologic results could be expected if free margin without tumor rupture was accomplished.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bergh P, Gunterberg B, Meis-Kindblom JM, Kindblom LG (2001) Prognostic factors and outcome of pelvic, sacral, and spinal chondrosarcomas: a center-based study of 69 cases. Cancer 91:1201–1212

    Article  PubMed  CAS  Google Scholar 

  2. Bergh P, Kindblom LG, Gunterberg B, Remotti F, Ryd W, Meis-Kindblom JM (2000) Prognostic factors in chordoma of the sacrum and mobile spine: a study of 39 patients. Cancer 88:2122–2134

    Article  PubMed  CAS  Google Scholar 

  3. Berven S, Zurakowski D, Mankin HJ, Gebhardt MC, Springfield DS, Hornicek FJ (2002) Clinical outcome in chordoma: utility of flow cytometry in DNA determination. Spine (Phila Pa 1976) 27(4):374–379

    Article  Google Scholar 

  4. Boriani S, Weinstein JN, Biagini R (1997) Primary bone tumors of the spine. Terminology and surgical staging. Spine 22:1036–1044

    Article  PubMed  CAS  Google Scholar 

  5. Cheng EY, Ozerdemoglu RA, Transfeldt EE, Thompson RC Jr (1999) Lumbosacral chordoma. Prognostic factors and treatment. Spine 24:1639–1645

    Article  PubMed  CAS  Google Scholar 

  6. Doita M, Harada T, Iguchi T, Sumi M, Sha H, Yoshiya S, Kurosaka M (2003) Total sacrectomy and reconstruction for sacral tumors. Spine 28:296–301

    Google Scholar 

  7. Evans RG, Nesbit ME, Gehan EA, Garnsey LA, Burgert O Jr, Vietti TJ, Cangir A, Tefft M, Thomas P, Askin FB et al (1991) Multimodal therapy for the management of localized Ewing’s sarcoma of pelvic and sacral bones: a report from the second intergroup study. J Clin Oncol 9:1173–1180

    PubMed  CAS  Google Scholar 

  8. Fourney DR, Gokaslan ZL (2003) Current management of sacral chordoma. Neurosurg Focus 15(2):E9

    Article  PubMed  Google Scholar 

  9. Fourney DR, Rhines LD, Hentschel SJ, Skibber JM, Wolinsky JP, Weber KL, Suki D, Gallia GL, Garonzik I, Gokaslan ZL (2005) En bloc resection of primary sacral tumors: classification of surgical approaches and outcome. J Neurosurg Spine 3:111–122

    Article  PubMed  Google Scholar 

  10. Gokaslan ZL, Romsdahl MM, Kroll SS, Walsh GL, Gillis TA, Wildrick DM, Leavens ME (1997) Total sacrectomy and Galveston L-rod reconstruction for malignant neoplasms. J Neurosurg 87:781–787

    Article  PubMed  CAS  Google Scholar 

  11. Huth JF, Dawson EG, Eilber FR (1984) Abdominosacral resection for malignant tumors of the sacrum. Am J Surg 148:157–161

    Article  PubMed  CAS  Google Scholar 

  12. Ishii K, Chiba K, Watanabe M, Yabe H, Fujimura Y, Toyama Y (2002) Local recurrence after S2–3 sacrectomy in sacral chordoma. Report of four cases. J Neurosurg 97(1 Suppl):98–101

    PubMed  Google Scholar 

  13. Simon MA, Springfield D (1998) Surgery for bone and soft-tissue tumors. Lippincott-Raven Publishers, Philadelphia, pp 444–450

    Google Scholar 

  14. McLoughlin GS, Sciubba DM, Suk I, Witham T, Bydon A, Gokaslan ZL, Wolinsky JP (2008) En bloc total sacrectomy performed in a single stage through a posterior approach. Neurosurgery 63(1 Suppl 1):ONS115–ONS120 discussion ONS120

    Article  PubMed  Google Scholar 

  15. Ozdemir MH, Gürkan I, Yildiz Y, Yilmaz C, Saglik Y (1999) Surgical treatment of malignant tumors of the sacrum. Eur Surg Oncol 25:44–49

    Article  CAS  Google Scholar 

  16. Randall RL, Bruckner J, Lloyd C, Pohlman TH, Conrad EU 3rd (2005) Sacral resection and reconstruction for tumors and tumor-like conditions. Orthopedics 28:307–313

    PubMed  Google Scholar 

  17. Samson IR, Springfield DS, Suit HD, Mankin HJ (1993) Operative treatment of sacrococcygeal chordoma. A review of twenty-one cases. J Bone Joint Surg Am 75:1476–1484

    PubMed  CAS  Google Scholar 

  18. Shikata J, Yamamuro T, Kotoura Y, Mikawa Y, Iida H, Maetani S (1998) Total sacrectomy and reconstruction for primary tumors. Report of two cases. J Bone Joint Surg Am 70:122–125

    Google Scholar 

  19. Stener B, Gunterberg B (1978) High amputation of the sacrum for extirpation of tumors. Principles and technique. Spine 3:351–366

    Article  PubMed  CAS  Google Scholar 

  20. Tang X, Guo W, Yang R, Tang S, Dong S (2010) Use of aortic balloon occlusion to decrease blood loss during sacral tumor resection. J Bone Joint Surg Am 92(8):1747–1753

    Article  PubMed  Google Scholar 

  21. Tang X, Guo W, Yang R, Tang S, Ji T (2009) Risk factors for blood loss during sacral tumor resection. Clin Orthop Relat Res 467(6):1599–1604

    Article  PubMed  Google Scholar 

  22. Tomita K, Tsuchiya H (1990) Total sacrectomy and reconstruction for huge sacral tumors. Spine 15:1223–1227

    Article  PubMed  CAS  Google Scholar 

  23. Touran T, Frost DB, O’Connell TX (1990) Sacral resection operative technique and outcome. Arch Surg 125:911–913

    Article  PubMed  CAS  Google Scholar 

  24. Wuisman P, Lieshout O, Sugihara S, van Dijk M (2000) Total sacrectomy and reconstruction: oncologic and functional outcome. Clin Orthop Relat Res 381:192–203

    Article  PubMed  Google Scholar 

  25. Yang RS, Eckardt JJ, Eilber FR, Rosen G, Forscher CA, Dorey FJ, Kelly CM, al-Shaikh R (1995) Surgical indications for Ewing’s sarcoma of the pelvis. Cancer 76:1388–1397

    Article  PubMed  CAS  Google Scholar 

  26. Yonemoto T, Tatezaki S, Takenouchi T, Ishii T, Satoh T, Moriya H (1999) The surgical management of sacrococcygeal chordoma. Cancer 85(4):878–883

    Article  PubMed  CAS  Google Scholar 

  27. York JE, Kaczaraj A, Abi-Said D, Fuller GN, Skibber JM, Janjan NA, Gokaslan ZL (1999) Sacral chordoma: 40 year experience at a major cancer center. Neurosurgery 44:74–8027

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors made no disclosures.

Author information

Authors and Affiliations

  1. Musculoskeletal Tumor Center, People’s Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China

    Dasen Li, Wei Guo, Xiaodong Tang, Tao Ji & Yidan Zhang

Authors
  1. Dasen Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wei Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiaodong Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tao Ji
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yidan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wei Guo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Li, D., Guo, W., Tang, X. et al. Surgical classification of different types of en bloc resection for primary malignant sacral tumors. Eur Spine J 20, 2275–2281 (2011). https://doi.org/10.1007/s00586-011-1883-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-011-1883-6

Keywords

Search

Navigation