Partial sacrectomy with en bloc tumor resection without instrumentation. What level is safe?

Area of Science:

• Oncology
• Surgical Oncology
• Radiotherapy

Background:

• En bloc sacrectomy is a radical surgical procedure for sacral tumors.
• Instrumentation is often used for stability after sacral resection.
• The necessity of instrumentation in all cases is debated.

Purpose of the Study:

• To evaluate the safety and necessity of instrumentation in en bloc sacrectomy.
• To determine if non-instrumented sacral resections provide adequate stability.
• To assess the impact of surgical approach on subsequent treatments like proton therapy.

Main Methods:

• Retrospective analysis of 29 sacral resections (2014-2023).
• Exclusion of patients with lumbosacral reconstruction or hemicorporectomy.
• Study group comprised 25 patients with various sacral tumor etiologies.

Main Results:

• Stress fractures occurred in elderly patients with low bone density and active younger patients.
• Non-instrumented procedures provided sufficient stability in most cases, regardless of bone mineral density.
• High en bloc sacrectomy retaining the cranial sacrum in situ was feasible without instrumentation.

Conclusions:

• Instrumentation is primarily indicated for younger, active patients.
• Non-instrumented en bloc sacrectomy offers sufficient stability for most patients.
• This approach creates favorable conditions for subsequent proton therapy.