SURGICAL TREATMENT OF SACROCOCCYGEAL CHORDOMA

Abstract

Aims: Chordoma is an uncommon malignant tumour with developing the remnants of notochord and usually manifesting itself in patients in their forties and fifties, aggressive local tumour in some cases resulting metastatic progression and might its histological picture show malignancy in long-lived patients. The objective are the presentation of the surgical technique of wide resection in the sacrococcygeal region, discuss the technical aspects of body wall reconstruction and presentation the long-term results of the surgical treatment of sacrococcygeal chordoma in our department.

Methods: Although we have treated 48 patients surgically between 1992 and 2005, this lecture includes 37 patients with at least 2 years follow-up. We applied wide resection in all cases and if it was necessary, reconstruction of the body wall was performed by insertingmetal wire frame and artificial fascia layer.

Results: We performed 48 wide resections, in 28 cases combined with reconstruction. Most of the patients have had local pain and 26 patients have had preoperative neurological symptoms. It was attained significant local pain relief in 90 percent of the patients and in 77 percent of the patients improvement of the neurological symptoms. Due to radiologically proved local recurrence of the tumour in twelve cases we had to perform second, and in two cases third surgery.

Conclusion: The wide resection of sacrococcygeal chordoma following with reconstruction of the body wall is a well designed and safe surgical procedure which results long survival in combining in certain cases with radiotherapy.