Staged sacrectomy--an adaptive approach

Area of Science:

• Surgical Oncology
• Orthopedic Surgery
• Oncology

Background:

• Sacral tumors often present late, making curative surgery technically challenging and associated with high morbidity.
• Complications of sacrectomy include infection, significant blood loss, functional deficits (bladder, bowel, sexual, gait), and spinopelvic nonunion.

Purpose of the Study:

• To analyze the complications and morbidity associated with sacrectomy.
• To evaluate modifications aimed at reducing surgical morbidity, specifically comparing sequential and staged abdominosacral approaches.

Main Methods:

• Retrospective study of 19 patients undergoing sacrectomy between 1997 and 2008.
• Surgical approaches included posterior, abdominolateral, and abdominosacral (sequential or staged).
• Functional outcomes assessed using the Enneking system; survival analysis via Kaplan-Meier method.

Main Results:

• The staged abdominosacral approach demonstrated reduced operating time, blood loss, and wound complications compared to other methods.
• Postoperative complications included bowel/bladder disturbances (47%) and wound issues (57.89%).
• Five-year overall survival was 70.4%, disease-free survival was 65%, with a local recurrence rate of 26.32%.

Conclusions:

• Sacrectomy is a feasible procedure with improved surgical techniques and modifications.
• The staged abdominosacral approach significantly reduces immediate postoperative morbidity.
• Use of a gluteal advancement flap and modern postoperative care further enhances safety and feasibility.