title: Preservation of the contralateral sacral nerves during hemisacrectomy for sacral malignancies.
abstract: OBJECTIVE
  This study aimed to evaluate the oncologic and functional outcome of the cases treated with hemisacrectomy through a sagittal plane in the sacrum and simultaneous en bloc resection together with the ipsilateral sacroiliac joint without sacrificing the contralateral sacral nerves and summarize tumor resection techniques and reconstruction strategy.
  
  
  METHODS
  En bloc resection of a sacral malignancy with ipsilateral sacroiliac joint and preservation of the contralateral sacral nerves by sagittal hemisacrectomy had been performed in 15 patients. An intra-abdominal aortic balloon was used in all these cases and a combined posterior-anterior approach was adopted. A modified Galveston technique was used to reestablish spinopelvic stability and a nonvascularized fibula autograft was used in selected cases.
  
  
  RESULTS
  Contralateral sacral nerves were preserved in all 15 patients. Adequate margins (wide and marginal margin) were accomplished in 10 patients. Local recurrence occurred in seven (47%) patients, and four of these had an inadequate margin. There was no perioperative death. Four (27%) patients had wound problems. No mechanical breakdown occurred until the last follow-up. All the patients were able to walk without the use of a walking aid. Sphincter function was partially preserved in all these patients. At the last follow-up, seven (47%) patients survived without evidence of disease, two (13%) patients lived with disease, and six (40%) patients had died of disease.
  
  
  CONCLUSIONS
  This procedure has an oncologic outcome that is similar to that of other high sacrectomy and a much better function outcome. Although demanding, it is indicated in selected patients.
authors.affiliation: Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China.
authors.forename: Dasen
authors.initials: D
authors.lastname: Li
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Tang
authors.forename: Rongli
authors.initials: R
authors.lastname: Yang
authors.forename: Shun
authors.initials: S
authors.lastname: Tang
authors.forename: Huayi
authors.initials: H
authors.lastname: Qu
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.forename: Xin
authors.initials: X
authors.lastname: Sun
authors.forename: Zhiye
authors.initials: Z
authors.lastname: Du
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002813:Chondrosarcoma / Q000601:surgery; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D012516:Osteosarcoma / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012007:Rectum / Q000502:physiology; D012189:Retrospective Studies; D012446:Sacroiliac Joint / Q000294:innervation / Q000601:surgery*; D012447:Sacrum / Q000294:innervation / Q000601:surgery*; D012512:Sarcoma, Ewing / Q000601:surgery; D013125:Spinal Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000502:physiology; D055815:Young Adult