Surgical Management of Large Sacral Spine Chordomas

Chordomas are rare malignant tumors arising from notochord remnants, predominantly in the sacral region. Due to their size and location, achieving R0 resection is challenging, with larger tumors (> 50 mm or > 25 cc) linked to worse outcomes. This study examines the surgical management and outcomes of large sacral chordomas, focusing on tumor size, resection strategy, and postoperative results. This retrospective study reviewed 14 male patients with sacral chordomas ≥ 50 mm or ≥ 25 cc. Data on demographics, tumor characteristics, surgical approaches, complications, and survival were analyzed using descriptive statistics and Kaplan-Meier survival curves. The study analyzed 14 male patients (mean age: 63.1 years) with sacral chordoma. Tumor size averaged 98.4 mm, and preoperative embolization was performed in two cases. Total sacrectomy was required in 14.3%, with spinopelvic fixation in both. Negative margins were achieved in 92.9%. Complications included wound issues (50%) and neurological deficits (57.1%)(7/12), mainly in high-level sacrectomies. High-level resections had significantly higher neurological complications (p = 0.005). Kaplan-Meier analysis estimated survival above 75% postoperatively. Surgical resection of large sacral chordomas is challenging but feasible, with high rates of R0 resection. Negative margins, tailored surgical strategies, and effective complication management are critical for optimizing outcomes.