A curative cryosurgical technique for advanced cancer of sacrococcygeal pilonidal sinuses

Malignant degeneration of pilonidal sinuses of the sacrococcygeal region is rare but quite serious, as the tumor soon perforates the sacral fascia and becomes adherent to the irregular posterior aspect of the sacrum, making it very difficult, if not impossible, to remove all neoplastic tissue by conventional surgery, hence the high recurrence rate and poor prognosis. A new cryosurgical technique to treat advanced sacrococcygeal pilonidal cancer is herein presented.

Seven men aged 30-75 (mean: 54.4 years) with advanced squamous-cell carcinomas (four primary, three recurrent) arising in sacrococcygeal pilonidal sinuses were treated with open and thick liquid nitrogen spray-two freeze-thaw cycles. Temperature monitoring was made by thermocouples.

Local eradication was achieved in all cases; one patient, however, died of metastatic disease 10 months after treatment, without local recurrence. One patient had a recurrence, or a new tumor, 8 years after treatment and was again submitted to aggressive cryosurgery followed by plastic surgery. He was followed for 14 years without recurrence. The follow-up of the remaining six patients ranges between 7 and 18 years.

To the author's knowledge, this is the first series of carcinomas of sacrococcygeal pilonidal sinuses successfully treated by cryosurgery.