[Surgical management of sacrococcygeal chordomas]

To analyze the surgical treatment results of 52 patients with sacral chordoma.

This retrospective study included 52 cases of sacrococcygeal chordoma surgically treated from December 1996 to July 2001 at the Department of Orthopaedic Surgery, Peking University People's Hospital, The ages of patients ranged from 18 to 80 years (mean 57 years), including of 35 males and 17 females. Nineteen patients had received surgical management at least once and 9 of them had received radiation therapy, whereas the other 33 patients had no surgery before they came to our department. Posterior approach and combined anterior-posterior approach were used in 43 and 9 cases respectively.

Based on a recent follow-up, 4 patients had died, and 3 of them died of metastatic chordoma. Among the other 46 patients who stayed alive, 35 were free from disease. The average follow-up time of the 35 disease-free patients was 42 months. In the 50 patients whose sacral nerve roots had been reserved bilaterally at and above S3 level, the sphincter muscle function of bladder and bowl was good, whereas the function of sphincter muscle impaired in 2 patients with nerve roots reserved only at and above S1 level. To manage these 2 patients, indwelling bladder catheters were used, but colostomy had not been performed. Local recurrence was observed in 7 of the 33 patients (21%) with the first surgery, and in 5 of the other 19 patients with second or third surgery.

Complete resection of tumor (radical surgery when possible) is the most effective way to manage sacrococcygeal chordomas. Postoperative adjuvant radiation therapy can reduce the tumor recurrence rate, but it also can cause troubles that would hinder further surgical managements. Even if the tumor is relatively huge and the upper resection margin is as high as at S1 or S2 level, the tumor can be removed successfully by posterior approach and the postoperative complications could be accepted. Though proper surgical procedures and adjuvant radiation can control the tumor locally, we have no optimal methods to prevent metastases from developing or to cure them when they are detected. One patient who developed metastases in lungs received chemotherapy, and good curative effect had been observed.