title: One-stage total en bloc sacrectomy: a novel technique and report of 9 cases.
abstract: METHODS
  Nine patients with malignant sacral tumor underwent 1-stage total sacrectomy. The oncological and functional results are analyzed.
  
  
  OBJECTIVE
  To describe the surgical technique and evaluate the clinical outcome of the surgery.
  
  
  BACKGROUND
  Very few reports specifically address total sacrectomy, and the 2-stage procedure combining the anterior and posterior approach is the most common method used for treatment.
  
  
  METHODS
  Between July 2007 and July 2010, 9 patients (7 males, 2 females; mean age, 33 yr; range, 13-59 yr) with malignant sacral tumor underwent 1-stage total sacrectomy the Peking University People's Hospital. The pathological diagnosis was chordoma in 3 patients, osteosarcoma in 2, chondrosarcoma in 2, malignant schwannoma in 1, and Ewing sarcoma in 1.
  
  
  RESULTS
  Oncological results: All 9 patients were followed-up for 11 to 35 months (mean follow-up time, 19.7 mo). Local recurrence was detected in the right ilium in the patient with Ewing sarcoma at 7 months after surgery, and locally in another patient with osteosarcoma at 3 months after surgery. The recurrent lesion in the right ilium was widely resected in the patient with Ewing sarcoma and no new lesion was found at the last follow-up, but this patient died of the lung metastases. The local recurrent lesion in the patient with osteosarcoma was treated with adjuvant chemotherapy and local radiation. Functional result: The S1 nerve root was cut bilaterally in 8 patients during surgery, resulting in the loss of foot plantar flexion. The 5 lumbar vertebrae were also resected with the sacrum in 1 patient, but the bilateral L5 nerve roots were preserved, and dorsiflexion was maintained in this patient.
  
  
  CONCLUSIONS
  Total sacrectomy can be performed successfully using a 1-stage combined anterior and posterior approach and is an important procedure for the treatment of primary malignant tumor involving the top portion of or the whole sacrum.
authors: Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China. bonetumor@163.com
authors: Wei
authors: W
authors: Guo
authors: Xiaodong
authors: X
authors: Tang
authors: Jie
authors: J
authors: Zang
authors: Tao
authors: T
authors: Ji
mesh_terms: D000293:Adolescent; D000328:Adult; D002813:Chondrosarcoma / Q000601:surgery; D002817:Chordoma / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009442:Neurilemmoma / Q000601:surgery; D019637:Orthopedic Procedures / Q000379:methods*; D012516:Osteosarcoma / Q000601:surgery; D012447:Sacrum / Q000473:pathology / Q000601:surgery*; D012512:Sarcoma, Ewing / Q000601:surgery; D013125:Spinal Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult