Complications and clinical outcomes of oncologic Sacrectomy: A systematic review and meta-analysis

Locally advanced primary or secondary sacral tumors may benefit from surgical treatment, and surgical treatment is indispensable today. However, the overall complication rates for resections and reconstructions requiring high-level techniques in this complex anatomical region remain subjective and do not fully reflect the current status of the literature. In this study, we systematically reviewed sacral resections for oncological reasons and aimed to reveal complications with meta-analysis.

We conducted a systematic review following PRISMA guidelines, searching PubMed for studies on sacrectomy and hemisacrectomy performed for oncological purposes. Eligible studies were in English, involved more than 10 patients, and focused on sacral tumors. Data were extracted and analyzed qualitatively and quantitatively. Effect sizes were calculated using fixed or random-effects models based on heterogeneity.

Twenty-eight studies met the inclusion criteria. The pooled 30-day complication rates were as follows: infections 26.6 %, reoperation 5.8 %, systemic complications 20.0 %, and mechanical failures 8.1 %. At 12 months, these rates increased, with infections reaching 32.2 % and reoperation rates 14.0 %. Subgroup analyses revealed that total sacrectomy and high-level resections (above S2) were associated with poorer functional outcomes, particularly in mobility and continence, while the surgical approach (anterior, posterior, or combined) did not significantly influence complication rates.

Sacrectomy for malignant tumors is a complex but essential procedure. High complication rates highlight the need for careful surgical planning, nerve root preservation when feasible, and coordinated multidisciplinary care to optimize outcomes and reduce morbidity.