Technique and surgical outcome of total resection of lower sacral tumor

To summarize the technique and surgical outcome for total resection of lower sacral tumor.

This retrospective study included 12 cases of total resection of lower sacral tumor (involving S3 and the below) from January 2010 to February 2013. Seven patients underwent en bloc resection and five cases accepted intralesional curettage. We used extraperitoneal approach to ligature the bilateral internal iliac artery, separated the tumor, and used transverse incision to separate the sacrum from surrounding ligaments and muscles. We then separated the sacrum to S2-S3 junction and ligatured the dural sac, cut off the sacrum at the S2-S3 junction, and remove the tumor out of the envelope. The other five patients underwent posterior surgery, which directly revealed lesions. Curettes were used under direct vision to scrape the tumor tissue.

All patients underwent the operation successfully without perioperative death or serious complication. The blood loss ranged from 300-650 mL (460 mL in average) in en bloc resection group. The blood loss ranged from 350-2800 mL (1595 mL in average) in curettage group. One case of transient enteroplegia and one case of transient gatism were respectively reported in en bloc resection group and one case of chronic pain in sacral was reported in curettage group. The postoperative pathological results revealed that there were 4 chordomas, 2 giant cell tumor and 1 metastatic tumor in en bloc resection group. All patients were followed up for 4-36 months (13.6 in average). At the final follow-up there was no recurrence reported. Two cases of local recurrence (40%) in curettage group were reported.

The surgery combined with anterior-posterior approach helped remove the lower sacral tumor totally, with uncomplicated surgical operations and obviously reduced recurrence rate. The recurrence rate was significantly reduced using curettage method.