Total sacrectomy and reconstruction - Oncologic and functional outcome

The oncologic and functional outcomes of nine patients who were treated by total sacrectomy through L5 (three cases) or L5-S1 (six cases) were reviewe d. Histologic diagnoses were one osteosarcoma, two giant cell tumors, two c hondrosarcomas, and four chordomas, Patients' ages ranged from 17 to 70 gea rs (mean age, 44.5 years). Resection margins mere intralesional (giant cell tumors) in two, marginal in one, and wide in six patients tone contaminate d). Reconstruction was performed using polymethylmethacrylate in two, screw and plate fixation in one, and a custom-made device in one. In five patien ts no reconstruction was performed. Five patients (45.5%) had wound complic ations: one had a wound dehiscence and two had deep infection; all needed s urgical reintervention. In addition, in one a ventral and in another a dors al hernia developed; only the ventral hernia was revised successfully. One patient had a deep vein thrombosis that was treated with a Coumadin derivat e. Three patients (33%) died after 14, 18, and 50 months postoperatively re spectively. One died of lung and widespread metastases, and two died of loc al recurrence and metastases. One patient with a giant cell tumor had a sol itary lung metastasis. After resection the patient has been disease-free mo re than 90 months. At followup, six patients had no evidence of disease (me an followup, 73 months; range, 30-120 months). Functionally, there was no c orrelation between patients who had a reconstruction and those who had not. Total sacrectomy is a valuable procedure to secure local tumor control and overall survival, despite potential complications and neurologic and sexua l dysfunction.