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European Spine Journal

, Volume 23, Issue 9, pp 1940–1948 | Cite as

“En bloc” resection of sacral chordomas by combined anterior and posterior surgical approach: a monocentric retrospective review about 29 cases

  • Arnaud DuboryEmail author
  • Gilles Missenard
  • Benoît Lambert
  • Charles Court
Original Article

Abstract

Purpose

“En bloc” resection of sacral chordomas (SC) with wide margins is statistically linked with a decrease of local recurrence (LR). Nevertheless, surgery potentially leads to complications and neurological deficits. The effectiveness of radiotherapy (RT) and chemotherapy (CT) remains controversial. The aim of the study was to evaluate the margins of tumor resection, the morbidity of “En bloc” resection of SC by combined anterior and posterior surgical approach and to look for predictive factors on survival and LR.

Methods

We performed sacrococcygectomy by surgical combined approach in 29 SC between 1985 and 2012. We analyzed overall survival and survival to LR with survival analysis using Kaplan–Meier method. Complications and morbidity were reported.

Results

The mean follow-up was of 77.9 months (0–241 months). We found 18 (62.1 %) postoperative infections and 7 (24.1 %) wound dehiscences. Eighteen patients had tumor wide margins (62.1 %), 6 marginal (20.7 %) and 4 intralesional (13.8 %). Seven patients had a LR (24.1 %). OS rate was 84.4 % at 5 and 10 years, survival rate with LR was 64 and 56 %, respectively, after 5 and 10 years. Quality of margins (p = 0.106), tumor volume (p = 0.103), postoperative RT (p = 0.245) and postoperative local infection (p = 0.754) did not have effect on LR.

Conclusion

“En bloc” resection by combined surgical approach seems to be a relevant alternative especially for SC invading the high sacrum above S3. Nevertheless, it yet remains the problem of postoperative infection. Systematic Adjuvant RT might allow better control on LR in association with surgery.

Keywords

Sacral chordoma Sacrectomy Surgical margins Postoperative radiotherapy Local recurrence 

Notes

Conflict of interest

None.

References

  1. 1.
    Siegel R, Ward E, Brawley O, Jemal A (2011) Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 61(4):212–236PubMedCrossRefGoogle Scholar
  2. 2.
    Riaz S, Fox R, Broad R (2007) Sacral chordoma. J Pak Med Assoc 57(6):328–330PubMedGoogle Scholar
  3. 3.
    McMaster ML, Goldstein AM, Bromley CM, Ishibe N, Parry DM (2001) Chordoma: incidence and survival patterns in the United States, 1973–1995. Cancer Causes Control 12(1):1–11PubMedCrossRefGoogle Scholar
  4. 4.
    Ruggieri P, Angelini A, Ussia G, Montalti M, Mercuri M (2010) Surgical margins and local control in resection of sacral chordomas. Clin Orthop Relat Res 468(11):2939–2947PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Dasenbrock HH, Clarke MJ, Bydon A, Witham TF, Sciubba DM, Simmons OP et al (2011) Reconstruction of extensive defects from posterior en bloc resection of sacral tumors using human acellular dermal matrix and gluteus maximus myocutaneous flaps. Neurosurgery. 69(6):1240–1247PubMedCrossRefGoogle Scholar
  6. 6.
    Fuchs B, Dickey ID, Yaszemski MJ, Inwards CY, Sim FH (2005) Operative management of sacral chordoma. J Bone Joint Surg Am 87(10):2211–2216PubMedCrossRefGoogle Scholar
  7. 7.
    Schwab JH, Healey JH, Rose P, Casas-Ganem J, Boland PJ (2009) The surgical management of sacral chordomas. Spine 34(24):2700–2704PubMedCrossRefGoogle Scholar
  8. 8.
    Zhang Z, Fu C, Yang Y, Wang L, Cui Y, Liu Y (2011) Long-term outcomes following en bloc resection for sacral tumor: a retrospective analysis of 93 cases. Orthopedics 34(8):e403–e407PubMedGoogle Scholar
  9. 9.
    Ozger H, Eralp L, Sungur M, Atalar AC (2010) Surgical management of sacral chordoma. Acta Orthop Belg 76(2):243–253PubMedGoogle Scholar
  10. 10.
    Hsieh PC, Xu R, Sciubba DM, McGirt MJ, Nelson C, Witham TF et al (2009) Long-term clinical outcomes following en bloc resections for sacral chordomas and chondrosarcomas: a series of twenty consecutive patients. Spine 34(20):2233–2239PubMedCrossRefGoogle Scholar
  11. 11.
    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(9):2122–2134PubMedCrossRefGoogle Scholar
  12. 12.
    Walcott BP, Nahed BV, Mohyeldin A, Coumans J-V, Kahle KT, Ferreira MJ (2012) Chordoma: current concepts, management, and future directions. Lancet Oncol. 13(2):e69–e76PubMedCrossRefGoogle Scholar
  13. 13.
    Zabel-du Bois A, Nikoghosyan A, Schwahofer A, Huber P, Schlegel W, Debus J et al (2010) Intensity modulated radiotherapy in the management of sacral chordoma in primary versus recurrent disease. Radiother Oncol 97(3):408–412.Google Scholar
  14. 14.
    Chen K, Yang H, Kandimalla Y, Liu J, Wang G (2009) Review of current treatment of sacral chordoma. Orthop Surg 1(3):238–244PubMedCrossRefGoogle Scholar
  15. 15.
    Diaz RJ, Cusimano MD (2011) The biological basis for modern treatment of chordoma. J Neurooncol 104(2):411–422PubMedCrossRefGoogle Scholar
  16. 16.
    Imai R, Kamada T, Sugahara S, Tsuji H, Tsujii H (2011) Carbon ion radiotherapy for sacral chordoma. Br J Radiol 84(Spec No 1):S48–S54Google Scholar
  17. 17.
    Nishida Y, Kamada T, Imai R, Tsukushi S, Yamada Y, Sugiura H et al (2011) Clinical outcome of sacral chordoma with carbon ion radiotherapy compared with surgery. Int J Radiat Oncol Biol Phys 79(1):110–116PubMedCrossRefGoogle Scholar
  18. 18.
    Schulz-Ertner D, Nikoghosyan A, Thilmann C, Haberer T, Jäkel O, Karger C et al (2004) Results of carbon ion radiotherapy in 152 patients. Int J Radiat Oncol Biol Phys 58(2):631–640PubMedCrossRefGoogle Scholar
  19. 19.
    Puri A, Agarwal MG, Shah M, Srinivas CH, Shukla PJ, Shrikhande SV et al (2009) Decision making in primary sacral tumors. Spine J 9(5):396–403PubMedCrossRefGoogle Scholar
  20. 20.
    Hulen CA, Temple HT, Fox WP, Sama AA, Green BA, Eismont FJ (2006) Oncologic and functional outcome following sacrectomy for sacral chordoma. J Bone Joint Surg Am 88(7):1532–1539PubMedCrossRefGoogle Scholar
  21. 21.
    Asavamongkolkul A, Waikakul S (2012) Wide resection of sacral chordoma via a posterior approach. Int Orthop 36(3):607–612PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Clarke MJ, Dasenbrock H, Bydon A, Sciubba DM, McGirt MJ, Hsieh PC et al (2012) Posterior-only approach for En Bloc sacrectomy: clinical outcomes in 36 consecutive patients. Neurosurgery 71(2):357–364PubMedCrossRefGoogle Scholar
  23. 23.
    Sabuncuoglu H, Ozdogan S, Dogan H, Ataoglu O, Tımurkaynak E (2010) Total resection of inferiorly located sacral chordoma with posterior only approach: case report and review of the literature. Turk Neurosurg 20(4):527–532PubMedGoogle Scholar
  24. 24.
    Dasenbrock H et al (2010) En bloc resection of sacral chordomas Aided by frameless stereotactic Image guidance: a technical note. Neurosurgery 70(Suppl Operative 1):82–87 discussion 87–8Google Scholar
  25. 25.
    Moojen WA, Vleggeert-Lankamp CLA, Krol ADG, Dijkstra SPD (2011) Long-term results: adjuvant radiotherapy in en bloc resection of sacrococcygeal chordoma is advisable. Spine 36(10):E656–E661PubMedCrossRefGoogle Scholar
  26. 26.
    Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 153:106–120PubMedGoogle Scholar
  27. 27.
    Ruggieri P, Angelini A, Pala E, Mercuri M (2012) Infections in surgery of primary tumors of the sacrum. Spine 37(5):420–428PubMedCrossRefGoogle Scholar
  28. 28.
    Chen KW, Yang HL, Lu J, Liu JY, Chen XQ (2010) Prognostic factors of sacral chordoma after surgical therapy: a study of 36 patients. Spinal Cord 48(2):166–171PubMedCrossRefGoogle Scholar
  29. 29.
    Chen K-W, Yang H-L, Lu J, Wang G-L, Ji Y-M, Bao Z-H et al (2011) Risk factors for postoperative wound infections of sacral chordoma after surgical excision. J Spinal Disord Tech 24(4):230–234PubMedCrossRefGoogle Scholar
  30. 30.
    Catton C, O’Sullivan B, Bell R, Laperriere N, Cummings B, Fornasier V et al (1996) Chordoma: long-term follow-up after radical photon irradiation. Radiother Oncol 41(1):67–72PubMedCrossRefGoogle Scholar
  31. 31.
    Cheng EY, Ozerdemoglu RA, Transfeldt EE, Thompson RC Jr (1999) Lumbosacral chordoma. Prognostic factors and treatment. Spine 24(16):1639–1645PubMedCrossRefGoogle Scholar
  32. 32.
    Park L, Delaney TF, Liebsch NJ, Hornicek FJ, Goldberg S, Mankin H et al (2006) Sacral chordomas: impact of high-dose proton/photon-beam radiation therapy combined with or without surgery for primary versus recurrent tumor. Int J Radiat Oncol Biol Phys 65(5):1514–1521PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Arnaud Dubory
    • 1
    • 2
    Email author
  • Gilles Missenard
    • 1
    • 2
  • Benoît Lambert
    • 3
  • Charles Court
    • 1
    • 2
  1. 1.Orthopaedic Department, Tumor and Spine UnitBicêtre University Hospital, AP-HP ParisLe Kremlin-BicêtreFrance
  2. 2.JE 2494Univ Paris-SudOrsayFrance
  3. 3.General Surgery DepartmentBicêtre University Hospital, AP-HP ParisLe Kremlin-BicêtreFrance

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