title: Infections in surgery of primary tumors of the sacrum.
abstract: METHODS
  Retrospective case series.
  
  
  OBJECTIVE
  To evaluate the risk of infection, related treatment, and outcome after surgery of the 2 most common primary sacral tumors.
  
  
  BACKGROUND
  Rarity of sacral tumors has limited the number of population-based studies. Treatment depends on malignancy or local aggressiveness: wide resection is indicated for malignant lesions, intralesional surgery for benign.
  
  
  METHODS
  We studied 82 patients with sacral chordomas (55 cases) or giant cell tumor (GCT) (27 cases) treated between 1976 and 2005. All patients had IV antibiotic therapy with amikacin and teicoplanin. Surgery of chordoma was resection; surgery of GCT was intralesional excision. Infections were classified as immediate postoperative, early (within 6 months), and late (more than 6 months from surgery). Mean follow-up was 9.5 years (range: 3-27 years). Some factors possibly influencing the risk of infection were statistically analyzed by Kaplan Meier curves and log-rank test.
  
  
  RESULTS
  No deep infections were observed in the GCT series. Three patients with sacral chordoma died for postoperative complications and were excluded from this analysis. Of the remaining 52 patients with chordoma, 23/52 had deep wound infection (44%) that required 1 or more surgical debridements combined with antibiotics, according to cultures. In 16 patients (70%), infection occurred within 4 weeks postoperatively, and in 7 within 6 months. Most frequent bacteria were Enterococcus (23%), Escherichia coli (20%), and Pseudomonas aeruginosa (18%). In 74% of cases, infection was multimicrobial. Level of resection, previous intralesional treatment elsewhere, tumor volume, and age did not statistically influence risk of infection.
  
  
  CONCLUSIONS
  Type of surgery was the prominent factor related to a major risk of infection. Operating procedure time correlated as well. Resections of sacral chordoma imply a high risk of deep infection, while intralesional excision of GCT does not. All infections healed with surgical debridements and antibiotic therapy.
authors.affiliation: Department of Orthopedics, University of Bologna, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ruggieri
authors.forename: Andrea
authors.initials: A
authors.lastname: Angelini
authors.forename: Elisa
authors.initials: E
authors.lastname: Pala
authors.forename: Mario
authors.initials: M
authors.lastname: Mercuri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002817:Chordoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D018212:Giant Cell Tumor of Bone / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012447:Sacrum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D055815:Young Adult