Navigation-guided resection of sacrococcygeal tumors: Case series with clinical and functional outcomes

Sacrococcygeal tumors are rare, slow-growing, and locally invasive, with surgical management complicated by proximity to critical neural structures. Wide resection remains the standard for local control but often results in significant morbidity, particularly voiding dysfunction. Intraoperative navigation has the potential to improve margin accuracy and facilitate nerve preservation. We retrospectively reviewed 6 consecutive patients who underwent navigation-guided sacrococcygeal tumor resection at a single-institution between November 2022 and June 2023. Clinical data included demographics, pathology, resection margin status (R0-R2), preservation of S3 roots, and postoperative voiding dysfunction requiring clean intermittent catheterization. The median patient age was 52.5 years; chordoma accounted for 67% of cases. R0 resection was obtained in 50% of patients. The median follow-up was 18.6 months (range, 10.1-24.2), with an overall median progression-free survival of 18.4 months. Patients with R0 resection showed a trend toward longer PFS compared with those with R1/R2 resections (23.1 vs 18.2 months). Both patients who underwent bilateral sacrifice of the S3 roots developed permanent voiding dysfunction. Among the 4 patients with preserved S3 roots, 3 experienced transient dysfunction that resolved over a median of 3.2 months, and one had no postoperative symptoms. Navigation-guided resection of sacrococcygeal tumors is technically feasible and may facilitate oncological precision while preserving critical nerve function. These early findings underscore the potential role of navigation in balancing local tumor control with quality-of-life outcomes. However, given the small sample size and short follow-up, the results should be considered preliminary, and larger prospective studies are warranted.