Total sacrectomy for primary multilevel malignant sacral tumors

Objective:To investigate the surgical approach and indication of total sacrectomy for primary multilevel malignant sacral tumors.Method:Between July 2007 and July 2009,6 patients with malignant sacral tumors received one-stage total sacrectomy by a combined anterior-posterior approach and rod-screw reconstruction in our center.There were 4 males and 2 females,with the average age of 38.8 years(range,20-59 years).S1-S4,S1-S3 and L5-S4 were involved in 4,1 and 1 patient respectively.Histological diagnoses were chordoma(2),chondrosarcoma(2),malignant peripheral nerve sheath tumor(1)and Ewing sarcoma(1).Result:The mean operation time was 12 hours(range,11-13 hours),with the mean intraoperative blood loss of 4500ml(range,3800-4500ml).There was no perioperative death and severe complications such as visceral leakage in all 6 patients.Bilateral S1 nerve roots were sacrificed in 6 patients and plantar flexion was not noted sequentially.Lumbosacral stability was reconstructed using rod-screw system in all cases.All patients were allowed to ambulate with the aid of crutches 6 weeks after operation.The mean follow-up was 10.3 months(range,3-25 months).No local recurrence or metastasis was found at final follow up.Conclusion:One-stage total sacrectomy with combined anterior-posterior approach can ensure satisfied oncological margin,however the indication should be strictly limited due to its great surgical challenge.