Faculty Opinions recommendation of Surgical Treatment of Sacral Chordoma: En Bloc Resection with Negative Margins is a Determinant of the Long-Term Outcome.

Abstract Background: En bloc resection, with adequate surgical margins, of primary malignant bone tumors of the sacrum is associated with long term disease control and potential cure. Resection of sacral tumors is difficult due to the proximity of neurovascular and visceral structures, and complete, or even partial, sacrectomy often results in functional loss for the patient. Objective: We describe the technique for en bloc resection of a sacral chordoma through a mid-sacral amputation. Results: We demonstrate successful removal of a large sacral tumor with wide surgical margins while preserving neurologic function. Conclusion: This technique for midsacral amputation to remove a sacral tumor en bloc minimizes local recurrence and maximizes neurovascular function.

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Faculty Opinions recommendation of Long-term outcome following surgical treatment of sacral chordoma.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727082172.793526072 ◽

2016 ◽

Author(s):

Carlos Bagley

Keyword(s):

Surgical Treatment ◽

Term Outcome ◽

Long Term Outcome ◽

Sacral Chordoma

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Outcomes of Surgery for Sacral Chordoma and Impact of Complications: A Report of 50 Consecutive Patients With Long-Term Follow-Up

Global Spine Journal ◽

10.1177/21925682211011444 ◽

2021 ◽

Vol 11 (5) ◽

pp. 740-750

Author(s):

Scott L. Zuckerman ◽

Sun-Ho Lee ◽

George J. Chang ◽

Garrett L. Walsh ◽

Reza J. Mehran ◽

...

Keyword(s):

Cox Regression ◽

Case Series ◽

Major Complication ◽

En Bloc Resection ◽

Bloc Resection ◽

Negative Margin ◽

Retrospective Case ◽

En Bloc ◽

Sacral Chordoma

Study Design: Retrospective case series. Objective: To determine predictive factors of overall survival (OS) and local recurrence (LR), report complications, and assess the impact of complications on survival, recurrence, and function in patients undergoing en bloc resection of sacral chordoma. Methods: This retrospective case series was obtained from a prospective database (1995-2016). All patients underwent en bloc resection of sacral chordoma. Demographic, perioperative, and complication data were collected. Outcomes included: overall survival(OS), local recurrence(LR), and complications. Survival analysis with multivariable cox regression was performed. Results: Among 50 patients, median follow-up was 5.3 years (range = 1.3-17.2). The majority (82%) underwent a negative margin resection. Survival: 17 patients died (34%) with a median OS of 10.0 years (range = 1.3-17.2). Multivariable cox regression revealed that a negative margin resection was not significantly associated with improved survival (HR = 3.35, 95%CI 0.87-12.80, P = .078). Recurrence: 20 patients (40%) experienced LR with a median time of 6.2 years (range = 0-16.9). Multivariable cox regression revealed that a negative margin resection was associated with a significant decreased risk of LR (HR = 4.96, 95%CI 1.84-13.34, P = 0.002,). A 62% overall complication rate was seen (42% major), with 26% reoperation rate. Of the reoperations, 54% were delayed (>6 weeks after the index surgery). Multivariable cox regression demonstrated that neither major complication nor reoperation significantly impacted OS (HR = 0.62, 95%CI 0.22-1.79, P = 0.380), LR (HR = 1.28, 95%CI 0.49-3.36, P = 0.611), or functional outcomes (OR = 2.94, 95%CI 0.25-34.8, P = 0.393). Conclusions: Negative margin resection was associated with decreased LR. Neither major complication nor reoperation significantly impacted OS, LR, or functional outcome. Though additional studies are needed, it appears that despite the morbidity associated with sacral chordoma resection, the long-term clinical outcomes are favorable.

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