[Orthopedic/visceral surgery cooperation in pelvic tumors]

Co-operation between orthopaedic surgeons and visceral surgeons is required in the treatment of malignant tumours of the pelvis when the rectum or the iliac vessels are infiltrated. Such infiltration can be expected in malignancies which originate in the sacrum. Most frequently, chordomas are found in this area, that should be resected with wide surgical margins even in advanced tumours to reduce the risk of local recurrence. When resecting the sacrum, the stability of the vertebral column and the pelvis is compromised only at levels above S2. After unilateral resection of the sacral nerve roots S2-S5, there are only minor impairments of the anal and bladder sphincter control. In the case of tumour infiltration of the rectum and simultaneous resection of the sacral nerve roots, abdominoperineal extirpation of the rectum is required even when a safe margin is left between the tumour and the anal sphincter. In different studies, the 5-year survival in patients with a malignancy of the sacrum varies between 52% and 84%. In view of the rarity of these tumours, treatment should be performed only at specialized centers where co-operation is ensured.