"En bloc" resection of sacral chordomas by combined anterior and posterior surgical approach: a monocentric retrospective review about 29 cases.
OBJECTIVE
"En bloc" resection of sacral chordomas (SC) with wide margins is statistically linked with a decrease of local recurrence (LR). Nevertheless, surgery potentially leads to complications and neurological deficits. The effectiveness of radiotherapy (RT) and chemotherapy (CT) remains controversial. The aim of the study was to evaluate the margins of tumor resection, the morbidity of "En bloc" resection of SC by combined anterior and posterior surgical approach and to look for predictive factors on survival and LR.


METHODS
We performed sacrococcygectomy by surgical combined approach in 29 SC between 1985 and 2012. We analyzed overall survival and survival to LR with survival analysis using Kaplan-Meier method. Complications and morbidity were reported.


RESULTS
The mean follow-up was of 77.9 months (0-241 months). We found 18 (62.1%) postoperative infections and 7 (24.1%) wound dehiscences. Eighteen patients had tumor wide margins (62.1%), 6 marginal (20.7%) and 4 intralesional (13.8%). Seven patients had a LR (24.1%). OS rate was 84.4% at 5 and 10 years, survival rate with LR was 64 and 56%, respectively, after 5 and 10 years. Quality of margins (p = 0.106), tumor volume (p = 0.103), postoperative RT (p = 0.245) and postoperative local infection (p = 0.754) did not have effect on LR.


CONCLUSIONS
"En bloc" resection by combined surgical approach seems to be a relevant alternative especially for SC invading the high sacrum above S3. Nevertheless, it yet remains the problem of postoperative infection. Systematic Adjuvant RT might allow better control on LR in association with surgery.
Orthopaedic Department, Tumor and Spine Unit, Bicêtre University Hospital, AP-HP Paris, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France, arnauddubory@hotmail.fr.
Arnaud
A
Dubory
Gilles
G
Missenard
Benoît
B
Lambert
Charles
C
Court
D000328:Adult; D000368:Aged; D002817:Chordoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D019637:Orthopedic Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery*; D013125:Spinal Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome