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Outcome of Sacropelvic Resection and Reconstruction Based on a Novel Classification System
Matthew T Houdek1, Elizabeth P Wellings, Steven L Moran
1Divisions of Plastic and Reconstructive Surgery (S.L.M. and K.B.) and Colorectal Surgery (E.J.D. and K.L.M.) and Department of Orthopedic Surgery (M.T.H., E.P.W., M.J.Y., F.H.S., and P.S.R.), Mayo Clinic, Rochester, Minnesota.
A new classification system for sacral tumor resections aids multidisciplinary communication and outcome prediction. This system helps guide surgical approach, staging, reconstruction, and functional outcomes for better patient care.
Area of Science:
- Oncology
- Surgical Oncology
- Orthopedic Surgery
Background:
- Sacral tumor resections necessitate a multidisciplinary strategy for curative and functional success.
- A standardized classification system is lacking for effective communication among surgical teams regarding approach, resection, reconstruction, and functional outcomes.
Purpose of the Study:
- To introduce and evaluate an outcomes-based classification system for sacral tumor resections.
Main Methods:
- A retrospective review of 196 patients who underwent oncologic en bloc sacrectomy.
- Patients were categorized based on the proposed classification system, detailing resection types and reconstruction needs.
- Mean follow-up was 7 years, with analysis of survival, recurrence, complications, and functional outcomes (Musculoskeletal Tumor Society score).
Main Results:
- The study included various sacrectomy types (1A-5), with 130 sarcomas (66%). Five-year disease-specific survival ranged from 34% (Type 1A) to 100% (Types 1B, 4, 5).
- Tumor recurrence occurred in 67 patients; local recurrence-free survival was 77% and metastasis-free survival was 68% at 5 years.
- Complications were frequent (78%), yet 79% of patients remained ambulatory with a mean MSTS93 score of 60%.
Conclusions:
- Sacral tumor resections, despite complications, can be curative with acceptable functional outcomes for most patients.
- The developed classification system facilitates interdisciplinary communication and aids in predicting surgical approach, staging, reconstruction, and functional results.
