Abstract
Objective
To evaluate functional and oncological outcomes following resection of sacral tumours and discuss the strategies for instrumentation.
Introduction
Primary malignant tumours of the sacrum are rare, arising from bony or neural elements, or bone marrow in haematological malignancies.
Management of such lesions is dictated by anatomy and the behaviour of tumours. Three key issues which arise are the adequacy of tumour resection, mechanical stabilisation and the need for colostomy. Stabilisation is often extensive and can be challenging.
Methods
A retrospective review of the surgical management of primary malignant sacral tumours from 2004 - 2009.
Results
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.
25 patients (54%) underwent surgical resection. 8 underwent instrumented stabilisations with fibula strut graft vs. 17 uninstrumented. Mechanical failure of stabilisation was noted in 75% over the follow up period but only one required revision surgery.
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. 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.
Conclusions
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
