title: Operative management of sacral chordoma.
abstract: BACKGROUND
  Sacrococcygeal chordoma presents a difficult diagnostic and therapeutic problem, with a high rate of local recurrence. The purpose of this report is to define the importance of adequate surgical treatment for optimum outcome and survival.
  
  
  METHODS
  Fifty-two patients underwent surgical treatment for sacrococcygeal chordoma between 1980 and 2001. The series included eighteen female patients and thirty-four male patients, with an average age of fifty-six years (range, thirteen to seventy-six years) at the time of the diagnosis. The surgical approach depended on the level and extent of the lesion, with a posterior approach performed in twenty-two patients and a combined anteroposterior approach used in thirty. A wide surgical margin was achieved in twenty-one patients.
  
  
  RESULTS
  At an average of 7.8 years (range, 2.1 to twenty-three years) postoperatively, twenty-three patients were alive with no evidence of disease. Twenty-three patients (44%) had local recurrence. The rate of recurrence-free survival was 59% at five years and 46% at ten years. The overall survival rates were 74%, 52%, and 47% at five years, ten years, and fifteen years, respectively. The most important predictor of survival was a wide margin. All patients with a wide margin survived, and this survival rate was significantly different from that for patients who had had either marginal or intralesional excision (p = 0.0001). Of the twenty-one patients with a wide margin, seventeen (81%) had undergone a combined anteroposterior approach and only four had been treated with a posterior approach.
  
  
  CONCLUSIONS
  A wide surgical margin is the most important predictor of survival and of local recurrence in patients with sacrococcygeal chordoma. Use of a combined anteroposterior approach increases the likelihood of obtaining a wide margin.
  
  
  METHODS
  Therapeutic Level IV.
authors.affiliation: Departments of Orthopedics and Surgical Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Bruno
authors.initials: B
authors.lastname: Fuchs
authors.forename: Ian D
authors.initials: ID
authors.lastname: Dickey
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Yaszemski
authors.forename: Carrie Y
authors.initials: CY
authors.lastname: Inwards
authors.forename: Franklin H
authors.initials: FH
authors.lastname: Sim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002817:Chordoma / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D019637:Orthopedic Procedures / Q000379:methods*; D012447:Sacrum; D013125:Spinal Neoplasms / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome