Surgical strategy for the management of sacral giant cell tumors: a 32-case series.
BACKGROUND
Surgical treatment of sacral giant cell tumors (GCTs) is associated with a high rate of complications, and there is controversy over which type of surgical treatment is optimal.


OBJECTIVE
To develop an optimal treatment strategy for sacral GCTs.


METHODS
Retrospective/academic medical center.


METHODS
A total of 32 patients (18 women and 14 men) with sacral GCT who underwent surgery between August 1996 and August 2008.


METHODS
Local recurrence rate, surgical margins, blood loss, sacral nerve root preservation, and complications.


METHODS
The medical charts of 32 patients were reviewed.


RESULTS
Patients underwent either wide resection (n=2), marginal resection (n=11), marginal resection plus curettage (n=12), or curettage alone (n=7). The curettage group and the wide resection group had the highest and lowest amounts of blood loss (4,500 vs. 1,300 mL, respectively). During follow-up (median, 42 months), 12 patients (37.5%) had local recurrence, including five of seven in the curettage group. The recurrence rate was significantly lower in the marginal excision group compared with that in the curettage group (18.2% vs. 71.4%, respectively; p=.049). Five patients had bladder dysfunction, and two patients had bowel dysfunction. Four patients who underwent marginal resection had lower limb dysfunction. Overall survival was 93.6%, and 2-year recurrence-free survival was 84.4%.


CONCLUSIONS
Choosing an optimal surgical margin in the treatment of sacral GCTs is of great importance for local recurrence control and sacral nerve root preservation. Curettage alone should not be used to treat sacral GCT.
Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Rd, Shanghai 200072, China.
Guodong
G
Li
Dong
D
Fu
Kai
K
Chen
Xiaojun
X
Ma
Mengxiong
M
Sun
Wei
W
Sun
Jian
J
Li
Zhendong
Z
Cai
D000328:Adult; D000368:Aged; D005260:Female; D005870:Giant Cell Tumors / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012447:Sacrum / Q000473:pathology* / Q000601:surgery*; D013125:Spinal Neoplasms / Q000601:surgery*; D055815:Young Adult