Level-adjusted perioperative risk of sacral amputations.

Area of Science:

• Oncology
• Surgical Oncology
• Orthopedic Surgery

Background:

• Sacral amputations above the S2 vertebral body present surgical challenges and are associated with long-term patient morbidity.
• Understanding the perioperative risks associated with the level of sacral resection is crucial for surgical planning and patient outcomes.

Purpose of the Study:

• To compare the perioperative morbidity of proximal sacral amputations (above S2) versus distal sacral amputations (below S2).
• To identify specific outcomes affected by the level of sacral resection in cancer surgery.

Main Methods:

• A retrospective evaluation of perioperative outcomes within 90 days of surgery for sacral amputations.
• Key outcome measures included estimated blood loss, intensive care unit (ICU) and hospital length of stay, hospital cost, and incidence of major and minor morbidities.
• Survival analyses were adjusted for resection level and tumor histology.

Main Results:

• Thirteen proximal and 14 distal sacral resections were analyzed.
• Proximal resections showed significantly higher median blood loss (4 L vs 1 L), ICU stay (4 days vs 0 days), hospital stay (19 days vs 8 days), and hospital cost ($28,800 vs $7,500).
• Major complications occurred in 85% of proximal resections versus 29% of distal resections (P = 0.011).

Conclusions:

• Tumor resections above the S2 vertebral body are associated with substantially increased perioperative morbidity.
• Proximal sacral osteotomies should be reserved for patients with a realistic potential for a complete cure.
• While resection level impacts morbidity, tumor type is a significant factor influencing patient survival.