Long-Term Bladder, Bowel, and Ambulatory Function After Sacrectomy Surgery

Retrospective cohort study.

To assess five-year bladder, bowel, and ambulatory function in patients receiving sacral tumor resection surgery.

Sacral tumors are rare and slow-growing, often leading to late diagnoses and large tumor sizes. Surgical resection is the standard of care, and frequently involves nerve root sacrifice. These structures are important for bladder, bowel, and ambulatory function, and previous studies have limited follow-up. Hence, little is known regarding how sacral nerve function changes over time after sacrectomy surgery.

We conducted a retrospective analysis of 43 patients who received surgery at our institution. Patients were stratified into groups based on osteotomy level (intralesional, low, mid, and high). Descriptive statistics were calculated with point estimates. Kruskal-Wallis tests were used to compare oncologic, surgical, and functional outcomes across sacrectomy groups. Cumulative link mixed models (CLMMs) were used to assess functional trends over time.

There were significant differences in preoperative and one-year bladder, bowel, and ambulatory function ( P <0.05). However, there were no significant differences between one-year and five-year bladder, bowel, and ambulatory function ( P =0.99, P =0.80, and P =0.72). At five years, bladder function was significantly better in the intralesional and low sacrectomy versus the mid sacrectomy group ( P =0.04 and P =0.002). At five years, bowel function was significantly better in the intralesional and low sacrectomy versus the mid sacrectomy group ( P =0.01 and P =0.01). At five years, the ambulatory function was significantly better in the low sacrectomy versus the high sacrectomy group ( P =0.006).

As expected, a higher osteotomy level was associated with poorer function. Bladder, bowel, and ambulatory function were shown to stabilize at one year postoperatively. This can serve as an assessment point for long-term function and can help set patient expectations after surgery.

Level III, cohort study.