[The surgical management of sacral tumors]

To investigate the way of sacral tumors surgical treatment.

This retrospective study included 119 cases of sacral tumors surgically treated from July, 1996 to December, 2001. The age of patients ranged from 18 to 80 years (mean 57 years), including of 72 male and 47 female. Out of the patients, there were 52 chordomas, 16 giant cell tumor, 5 neurofibroma, 23 metastases tumors, 9 myeloma, 2 osteoblastomas, 5 aneurysmal bone cysts, 3 osteosarcomas, 4 chondrosarcomas. Posterior approach and combined anterior-posterior approach were used in 83 and 36 cases respectively. Twenty-nine patients had received surgical management at least once and 16 of them had received radiation therapy before came to our department.

Three patients died on the complication around the surgery. Most of the patients with metastases tumor or multiple myeloma died 1 to 3 years after the surgery. Out of three osteosarcoma patients, 2 died and one alive with tumor. Three chondrosarcoma patients died, and one alive with tumor. Out of 52 chordoma patients, 3 patients had died of metastatic chordoma, 3 patients died of many times recurrence. Among the other 46 patients who were stay alive, 31 were free from disease with average follow-up time of 42 months. In the patients whose sacral nerve roots had been reserved bilaterally at and above S(3) level, the sphincter muscle function of bladder and bowl was good. While the function of sphincter muscle impaired in 2 patients with nerve roots reserved only at and above S(1) level. To manage these 2 patients, indwelling bladder catheters were used, but colostomy had not been performed.

Complete resection of tumor (radical surgery when possible) is the most effective way to manage sacral tumors. 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 S(1) or S(2) level, the tumor can be removed successfully by posterior approach and the postoperative complications could be accepted. To the patients with aneurysmal cyst or giant cell tumor on sacrum, for control bleeding purpose, anterior approach should be performed to ligate the bilateral internal iliac artery.