Acta Neurochirurgica

, Volume 161, Issue 12, pp 2433–2441 | Cite as

Recurrence or neurological loss? Resection mode selection for patients with large sacral chordoma: an analysis of prognostic factors and quality of life

  • Xin Gao
  • Qi Jia
  • Xiaopan Cai
  • Chenglong Zhao
  • Jiaxiang Yang
  • Lianfeng Dong
  • Guangjian Bai
  • Baoquan Xin
  • Wei Wan
  • Tielong Liu
  • Jianru XiaoEmail author
Original Article - Tumor - Other
Part of the following topical collections:
  1. Tumor – Other



Surgical resection represents the main therapeutic method for sacral chordoma, but plans for resection mode must weigh neurological loss against complete tumor excision, a difficult balance to strike. The purpose of this study was to provide useful information contributing to surgical decision making in sacral chordoma.


A retrospective review was performed on 47 patients with large sacral chordoma. Prognostic factors affecting recurrence-free survival (RFS) and overall survival (OS) were analyzed using the Kaplan–Meier method and Cox proportional hazards model. Quality of life was assessed by the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire and compared using Student’s t test.


Resection mode was the independent prognostic factor affecting RFS, while independent prognostic factors affecting OS were resection mode and postoperative recurrence. As for quality of life, the en bloc resection group showed a higher score in emotional well-being, while the piecemeal resection group scored better in function well-being. No significant difference was identified in total the FACT-G score between two groups.


On the one hand, en bloc resection showed huge advantages in disease control for sacral chordoma. On the other hand, despite the unsatisfaction in functional well-being, en bloc resection did not sacrifice quality of life significantly in terms of the total FACT-G score.


Chordoma Sacral tumor Sacrectomy En bloc resection Piecemeal resection Prognostic factor Quality of life 


Funding information

This work was financially supported by key project funding in the basic research field of the Shanghai Municipal Science and Technology Commission (17JC1400903). The sponsor had no role in the design or conduct of this research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For retrospective study, formal consent is not required.


  1. 1.
    Angelini A, Pala E, Calabro T, Maraldi M, Ruggieri P (2015) Prognostic factors in surgical resection of sacral chordoma. J Surg Oncol 112:344–351. CrossRefPubMedGoogle Scholar
  2. 2.
    Asavamongkolkul A, Waikakul S (2012) Wide resection of sacral chordoma via a posterior approach. Int Orthop 36:607–612. CrossRefPubMedGoogle Scholar
  3. 3.
    Boriani S, Weinstein JN, Biagini R (1997) Primary bone tumors of the spine. Terminology and surgical staging. Spine 22:1036–1044CrossRefGoogle Scholar
  4. 4.
    Chandawarkar RY (1996) Sacrococcygeal chordoma: review of 50 consecutive patients. World J Surg 20:717–719CrossRefGoogle Scholar
  5. 5.
    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 48:166–171. CrossRefPubMedGoogle Scholar
  6. 6.
    Colangeli S, Muratori F, Bettini L, Frenos F, Totti F, D’Arienzo A, Campo FR, Scoccianti G, Beltrami G, Campanacci DA, Capanna R (2018) Surgical treatment of sacral chordoma: en bloc resection with negative margins is a determinant of the long-term outcome. Surg Technol Int 33:343–348PubMedGoogle Scholar
  7. 7.
    Davidge KM, Eskicioglu C, Lipa J, Ferguson P, Swallow CJ, Wright FC (2010) Qualitative assessment of patient experiences following sacrectomy. J Surg Oncol 101:447–450. CrossRefPubMedGoogle Scholar
  8. 8.
    Denaro L, Berton A, Ciuffreda M, Loppini M, Candela V, Brandi ML, Longo UG (2018) Surgical management of chordoma: a systematic review. J Spinal Cord Med 1–16.
  9. 9.
    Dhawale AA, Gjolaj JP, Holmes L Jr, Sands LR, Temple HT, Eismont FJ (2014) Sacrectomy and adjuvant radiotherapy for the treatment of sacral chordomas: a single-center experience over 27 years. Spine 39:E353–E359. CrossRefPubMedGoogle Scholar
  10. 10.
    Dubory A, Missenard G, Lambert B, Court C (2014) “En bloc” resection of sacral chordomas by combined anterior and posterior surgical approach: a monocentric retrospective review about 29 cases. Eur Spine J 23:1940–1948. CrossRefPubMedGoogle Scholar
  11. 11.
    Enneking WF (1986) A system of staging musculoskeletal neoplasms. Clin Orthop Relat Res 9–24Google Scholar
  12. 12.
    Farsad K, Kattapuram SV, Sacknoff R, Ono J, Nielsen GP (2009) Sacral chordoma. Radiographics 29:1525–1530. CrossRefPubMedGoogle Scholar
  13. 13.
    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. CrossRefPubMedGoogle Scholar
  14. 14.
    Guiu S, Guiu B, Feutray S, Chauffert B (2009) Direct intratumoral chemotherapy with carboplatin and epinephrine in a recurrent cervical chordoma: case report. Neurosurgery 65:E629–E630; discussion E630. CrossRefPubMedGoogle Scholar
  15. 15.
    Hsieh PC, Xu R, Sciubba DM, McGirt MJ, Nelson C, Witham TF, Wolinksy JP, Gokaslan ZL (2009) Long-term clinical outcomes following en bloc resections for sacral chordomas and chondrosarcomas: a series of twenty consecutive patients. Spine 34:2233–2239. CrossRefPubMedGoogle Scholar
  16. 16.
    Ji T, Guo W, Yang R, Tang X, Wang Y, Huang L (2017) What are the conditional survival and functional outcomes after surgical treatment of 115 patients with sacral chordoma? Clin Orthop Relat Res 475:620–630. CrossRefPubMedGoogle Scholar
  17. 17.
    Kayani B, Sewell MD, Tan KA, Hanna SA, Williams R, Pollock R, Skinner J, Briggs TW (2015) Prognostic factors in the operative management of sacral chordomas. World Neurosurg 84:1354–1361. CrossRefPubMedGoogle Scholar
  18. 18.
    Lee MH, Kim SR, Jeong JS, Lee EJ, Lee YC (2012) Pulmonary metastatic chordoma improved by platinum-based chemotherapy. Lung Cancer 76:255–257. CrossRefPubMedGoogle Scholar
  19. 19.
    Lipscomb J, Gotay CC, Snyder CF (2007) Patient-reported outcomes in cancer: a review of recent research and policy initiatives. CA Cancer J Clin 57:278–300. CrossRefPubMedGoogle Scholar
  20. 20.
    Moran D, Zadnik PL, Taylor T, Groves ML, Yurter A, Wolinsky JP, Witham TF, Bydon A, Gokaslan ZL, Sciubba DM (2015) Maintenance of bowel, bladder, and motor functions after sacrectomy. Spine J 15:222–229. CrossRefPubMedGoogle Scholar
  21. 21.
    Palthe O, Tromp I, Ferreira A, Fiore A, Bramer JAM, van Dijk NC, DeLaney TF, Schwab JH, Hornicek FJ (2019) Sacral chordoma: a clinical review of 101 cases with 30-year experience in a single institution. Spine J 19:869–879. CrossRefGoogle Scholar
  22. 22.
    Pennicooke B, Laufer I, Sahgal A, Varga PP, Gokaslan ZL, Bilsky MH, Yamada YJ (2016) Safety and local control of radiation therapy for chordoma of the spine and sacrum: a systematic review. Spine 41(Suppl 20):S186–S192. CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Phukan R, Herzog T, Boland PJ, Healey J, Rose P, Sim FH, Yazsemski M, Hess K, Osler P, DeLaney TF, Chen YL, Hornicek F, Schwab J (2016) How does the level of sacral resection for primary malignant bone tumors affect physical and mental health, pain, mobility, incontinence, and sexual function? Clin Orthop Relat Res 474:687–696. CrossRefPubMedGoogle Scholar
  24. 24.
    Radaelli S, Stacchiotti S, Ruggieri P, Donati D, Casali PG, Palmerini E, Collini P, Gambarotti M, Porcu L, Boriani S, Gronchi A, Picci P (2016) Sacral chordoma: long-term outcome of a large series of patients surgically treated at two reference centers. Spine 41:1049–1057. CrossRefPubMedGoogle Scholar
  25. 25.
    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 468:2939–2947. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Schwab JH, Healey JH, Rose P, Casas-Ganem J, Boland PJ (2009) The surgical management of sacral chordomas. Spine 34:2700–2704. CrossRefPubMedGoogle Scholar
  27. 27.
    Sciubba DM, Petteys RJ, Garces-Ambrossi GL, Noggle JC, McGirt MJ, Wolinsky JP, Witham TF, Gokaslan ZL (2009) Diagnosis and management of sacral tumors. J Neurosurg Spine 10:244–256. CrossRefPubMedGoogle Scholar
  28. 28.
    Spalato Ceruso M, Napolitano A, Silletta M, Vincenzi B (2019) Unexpected benefit from an ‘old’ metronomic chemotherapy regimen in advanced chordoma. BMJ Case Rep 12. CrossRefGoogle Scholar
  29. 29.
    van Wulfften Palthe ODR, Janssen SJ, Wunder JS, Ferguson PC, Wei G, Rose PS, Yaszemski MJ, Sim FH, Boland PJ, Healey JH, Hornicek FJ, Schwab JH (2017) What questionnaires to use when measuring quality of life in sacral tumor patients: the updated sacral tumor survey. Spine J 17:636–644. CrossRefPubMedGoogle Scholar
  30. 30.
    van Wulfften Palthe ODR, Tromp I, Ferreira A, Fiore A, Bramer JAM, van Dijk NC, DeLaney TF, Schwab JH, Hornicek FJ (2019) Sacral chordoma: a clinical review of 101 cases with 30-year experience in a single institution. Spine J 19:869–879. CrossRefPubMedGoogle Scholar
  31. 31.
    Varga PP, Szoverfi Z, Fisher CG, Boriani S, Gokaslan ZL, Dekutoski MB, Chou D, Quraishi NA, Reynolds JJ, Luzzati A, Williams R, Fehlings MG, Germscheid NM, Lazary A, Rhines LD (2015) Surgical treatment of sacral chordoma: prognostic variables for local recurrence and overall survival. Eur Spine J 24:1092–1101. CrossRefPubMedGoogle Scholar
  32. 32.
    Walcott BP, Nahed BV, Mohyeldin A, Coumans JV, Kahle KT, Ferreira MJ (2012) Chordoma: current concepts, management, and future directions. Lancet Oncol 13:e69–e76. CrossRefPubMedGoogle Scholar
  33. 33.
    Wan C, Yang Z, Meng Q, Feng C, Wang H, Tang X, Zhang C, Lu Y, Luo J, Zhang X (2008) Development and validation of the general module of the system of quality of life instruments for cancer patients. Int J Cancer 122:190–196. CrossRefPubMedGoogle Scholar
  34. 34.
    Xie C, Whalley N, Adasonla K, Grimer R, Jeys L (2015) Can local recurrence of a sacral chordoma be treated by further surgery? Bone Joint J 97-B:711–715. CrossRefPubMedGoogle Scholar
  35. 35.
    Yang Y, Niu X, Li Y, Liu W, Xu H (2017) Recurrence and survival factors analysis of 171 cases of sacral chordoma in a single institute. Eur Spine J 26:1910–1916. CrossRefPubMedGoogle Scholar
  36. 36.
    Zang J, Guo W, Yang R, Tang X, Li D (2015) Is total en bloc sacrectomy using a posterior-only approach feasible and safe for patients with malignant sacral tumors? J Neurosurg Spine 22:563–570. CrossRefPubMedGoogle Scholar
  37. 37.
    Zoccali C, Skoch J, Patel AS, Walter CM, Maykowski P, Baaj AA (2016) Residual neurological function after sacral root resection during en-bloc sacrectomy: a systematic review. Eur Spine J 25:3925–3931. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Xin Gao
    • 1
  • Qi Jia
    • 1
  • Xiaopan Cai
    • 1
  • Chenglong Zhao
    • 1
  • Jiaxiang Yang
    • 1
    • 2
  • Lianfeng Dong
    • 1
    • 2
  • Guangjian Bai
    • 1
    • 3
  • Baoquan Xin
    • 1
    • 3
  • Wei Wan
    • 1
  • Tielong Liu
    • 1
  • Jianru Xiao
    • 1
    Email author
  1. 1.Orthopaedic Oncology Center, Department of Orthopaedics, Changzheng HospitalSecond Military Medical UniversityShanghaiChina
  2. 2.Anhui University of Chinese MedicineHefeiChina
  3. 3.Shandong First Medical UniversityTaianChina

Personalised recommendations