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Surgical Margins and Local Control in Resection of Sacral Chordomas

  • Symposium: Highlights of the ISOLS/MSTS 2009 Meeting
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The treatment of choice in sacral chordoma is surgical resection, although the risk of local recurrence and metastasis remains high. The quality of surgical margins obtained at initial surgery is the primary factor to improve survival reducing the risk of local recurrence, but proximal sacral resections are associated with substantial perioperative morbidity.

Questions/purposes

We considered survivorship related to local recurrence in terms of surgical margins, level of resection, and previous surgery.

Methods

We retrospectively reviewed 56 patients with sacral chordomas treated with surgical resection. Thirty-seven were resected above S3 by a combined anterior and posterior approach and 19 at or below S3 by a posterior approach. Nine of these had had previous intralesional surgery elsewhere. The minimum followup was 3 years (mean, 9.5 years; range, 3–28 years).

Results

Overall survival was 97% at 5 years, 71% at 10 years, and 47% at 15 years. Survivorship to local recurrence was 65% at 5 years and 52% at 10 years. Thirty percent of patients developed metastases. Wide margins were associated with increased survivorship to local recurrence. We found no differences in local recurrence between wide and wide-contaminated margins (that is, if the tumor or its pseudocapsule was exposed intraoperatively, but further tissue was removed to achieve wide margins). Previous intralesional surgery was associated with an increased local recurrence rate. We observed no differences in the recurrence rate in resections above S3 or at and below S3.

Conclusions

Surgical margins affect the risk of local recurrence. Previous intralesional surgery was associated with a higher rate of local recurrence. Intraoperative contamination did not affect the risk of local recurrence when wide margins were subsequently attained.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Dr Marco Alberghini for the histologic evaluation; Dr Eugenio Rimondi for the imaging analysis; Prof Antonio Briccoli and Dr Michele Rocca for surgical assistance of most patients in this series; and Dr Andreas F. Mavrogenis for reviewing our paper. Special thanks to Mrs Alba Balladelli, BA, who reviewed our paper and substantially improved our English.

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Authors and Affiliations

  1. Department of Orthopedics, University of Bologna, Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna (BO), Italy

    Pietro Ruggieri MD, PhD, Andrea Angelini MD, Giuseppe Ussia MD, Maurizio Montalti MD & Mario Mercuri MD

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  1. Pietro Ruggieri MD, PhD
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  2. Andrea Angelini MD
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  3. Giuseppe Ussia MD
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  4. Maurizio Montalti MD
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  5. Mario Mercuri MD
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Correspondence to Pietro Ruggieri MD, PhD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Ruggieri, P., Angelini, A., Ussia, G. et al. Surgical Margins and Local Control in Resection of Sacral Chordomas. Clin Orthop Relat Res 468, 2939–2947 (2010). https://doi.org/10.1007/s11999-010-1472-8

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