title: Prognostic factors in surgical resection of sacral chordoma.
abstract: OBJECTIVE
  The best treatment of sacral chordoma is surgical resection, nowadays associated with optimized radiation therapy. We analysed 1) the oncologic outcome in a large series; 2) the effect of previous intralesional surgery, resection level, tumor volume and margins on survivorship to local recurrence (LR) and 3) the complication rate.
  
  
  METHODS
  We reviewed 71 patients with sacral chordomas. Forty-eight resections were proximal to S3. Mean tumor volume was 535 cm3. Eleven received previous intralesional surgery elsewhere. Margins were wide in 44 resections, wide-contaminated in 11, marginal in 9 and intralesional in 7.
  
  
  RESULTS
  Overall survival was 92%, 65% and 44% at 5, 10 and 15 years. At a mean of 9.5 years 37 were NED (54.4%), 23 died with disease (33.8%) and 8 were alive with disease (11.7%). Relapses included 15 LRs, 6 distant metastases, 17 both. LR rate was significantly higher in patients with previous surgery (p=0.0217), with inadequate margins (p= 0.0339) and large tumors(p<0.01), whereas resection level was not significant. Multivariate analysis confirmed the role of tumor volume. Complication rate was high (80.9%) with an infection rate of 41.2%.
  
  
  CONCLUSIONS
  The most prominent adverse factor for LR was previous intralesional surgery. LR rate was related with inadequate margins and tumor volume.
authors.affiliation: Department of Orthopedics, Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Angelini
authors.affiliation: Department of Orthopedics, Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Pala
authors.affiliation: Department of Orthopedics, Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Calabrò
authors.affiliation: Department of Orthopedics, Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Maraldi
authors.affiliation: Department of Orthopedics, Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ruggieri
mesh_terms: D000328:Adult; D000368:Aged; D002817:Chordoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012447:Sacrum / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D055815:Young Adult
keywords: chordoma; prognostic factors; resection; sacral surgery; sacrum; tumor