Two-stage therapy in the treatment of sacral tumors

Sacral tumors are rare and may be clinically overlooked for a long period, because the symptoms and signs are often mild and non-specific. This led to frequent errors in clinical diagnosis and a long delay between the onset of symptoms and treatment. On presentation the lesions frequently expanded the anterior cortex, however, in most patients the periosteum of the sacrum and the presacral fascia form an unbroken barrier for a tumor. The pelvic viscera are not infiltrated by the tumor until late. Wide excision is difficult and often causes urogenital and/or anorectal dysfunction, but preserving the sacral nerve roots often leads to local recurrence. Surgical wide excision with a combined anterior-posterior approach is considered the treatment of choice for large lesions with significant anterior intrapelvic extension. This paper reports data resulting from the treatment of five large sacral tumors with comments on the results.