Abstract
To evaluate functional and oncological outcomes following resection of primary malignant bone tumours.
Primary malignant tumours of the sacrum are rare, arising from bony or neural elements, or bone marrow in haematological malignancies.
Management of these lesions is dictated by anatomical considerations and the behaviour of tumours. The three key issues which arise are the adequacy of tumour resection, mechanical stabilisation and the need for colostomy.
A retrospective review of the surgical management of primary malignant sacral tumours from 2004 - 2009.
The study included 46 patients (34 males, 12 females) with an average age of 49 (range 7 – 82). Median duration of symptoms before presentation was 26 months.
10 patients had inoperable tumours at presentation. 6 patients had chemotherapy. 2 patients opted for palliative radiotherapy. 1 patient was unfit for surgery.
25 patients (54%) underwent surgical resection. 8 underwent instrumented stabilisations with fibula strut graft vs. 17 uninstrumented.
Colostomy was performed in 10 patients (40%). Mean follow post-operatively was 19.0 months.
Wound healing problems were present in 5/25 (20%). There was no difference in infection rates between definitive surgery with and without colostomy. Mechanical failure of stabilisation was noted in 75%. There was one peri-operative death.
Local recurrence occurred in 12%(3/25) of operated patients although follow-up period was noted to be short.
Mechanical stabilisation for extensive lesions in the sacrum are particularly challenging in tumour surgery. Despite radiological failure in 7/8 instrumented stabilisations, patients were relatively asymptomatic and only 1/8 required revision stabilisation surgery.
Ethics approval: None: Audit Interest Statement: None
