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Extended total sacrectomy and reconstruction for sacral tumor
Norihide Ohata1, Toshifumi Ozaki, Toshiyuki Kunisada
1Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
Spine
|March 12, 2004
Summary
Extended sacrectomy successfully treated a pediatric sarcoma, enabling a patient to walk with crutches after five years. This radical resection offers a potential cure for aggressive sacral tumors.
Area of Science:
- Oncology
- Surgical Oncology
- Pediatric Oncology
Background:
- Sacral tumors frequently present at advanced stages with significant volume.
- Extended total sacrectomy is the only curative surgical option for massive sacral tumors.
- Total sacrectomy carries substantial risks and complications, complicating treatment decisions.
Observation:
- A 13-year-old male diagnosed with sacral sarcoma with extraskeletal extension and iliac infiltration.
- Initial diagnosis of synovial sarcoma, later reclassified as unclassified sarcoma via genetic analysis.
- Tumor exhibited a 50% size reduction after neoadjuvant chemotherapy and radiotherapy.
Findings:
- Extended total sacrectomy was performed with L5 vertebral body fixation and pelvic ring compression.
- ISOLA instrumentation stabilized the lumbar spine and ilia; sacral nerve roots and left L5 root were transected.
- At 5-year follow-up, the patient was disease-free, ambulatory with crutches, and capable of stair climbing with assistance.
Implications:
- Preoperative neoadjuvant therapy significantly contributed to the favorable long-term outcome.
- Extended sacrectomy, despite its challenges, can achieve radical tumor removal and functional recovery.
- The choice between radical resection and less extensive combined therapy for sacral tumors remains a subject of debate.