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Abstract：
BACKGROUND: Bone sarcoma or direct pelvic carcinoma invasion of the sacrum represent indications for partial or total sacrectomy. The aim was to describe the oncosurgical management and complication profile and to analyze our own outcome results following sacrectomy.
METHODS: In a retrospective analysis, 27 patients (n = 8/10/9 sarcoma/chordoma/locally recurrent rectal cancer (LRRC)) were included. There was total sacrectomy in 9 (incl. combined L5 en bloc spondylectomy in 2), partial in 10 and hemisacrectomy in 8 patients. In 12 patients, resection was navigation-assisted. For reconstruction, an omentoplasty, VRAM-flap or spinopelvic fixation was performed in 20, 10 and 13 patients, respectively.
RESULTS: With a median follow-up (FU) of 15 months, the FU rate was 93%. R0-resection was seen in 81.5% (no significant difference using navigation), and 81.5% of patients suffered from one or more minor-to-moderate complications (especially wound-healing disorders/infection). The median overall survival was 70 months. Local recurrence occurred in 20%, while 44% developed metastases and five patients died of disease.
CONCLUSIONS: Resection of sacral tumors is challenging and associated with a high complication profile. Interdisciplinary cooperation with visceral/vascular and plastic surgery is essential. In chordoma patients, systemic tumor control is favorable compared to LRRC and sarcomas. Navigation offers gain in intraoperative orientation, even if there currently seems to be no oncological benefit. Complete surgical resection offers long-term survival to patients undergoing sacrectomy for a variety of complex diseases.
METHODS: In a retrospective analysis, 27 patients (n = 8/10/9 sarcoma/chordoma/locally recurrent rectal cancer (LRRC)) were included. There was total sacrectomy in 9 (incl. combined L5 en bloc spondylectomy in 2), partial in 10 and hemisacrectomy in 8 patients. In 12 patients, resection was navigation-assisted. For reconstruction, an omentoplasty, VRAM-flap or spinopelvic fixation was performed in 20, 10 and 13 patients, respectively.
RESULTS: With a median follow-up (FU) of 15 months, the FU rate was 93%. R0-resection was seen in 81.5% (no significant difference using navigation), and 81.5% of patients suffered from one or more minor-to-moderate complications (especially wound-healing disorders/infection). The median overall survival was 70 months. Local recurrence occurred in 20%, while 44% developed metastases and five patients died of disease.
CONCLUSIONS: Resection of sacral tumors is challenging and associated with a high complication profile. Interdisciplinary cooperation with visceral/vascular and plastic surgery is essential. In chordoma patients, systemic tumor control is favorable compared to LRRC and sarcomas. Navigation offers gain in intraoperative orientation, even if there currently seems to be no oncological benefit. Complete surgical resection offers long-term survival to patients undergoing sacrectomy for a variety of complex diseases.
摘要：
背景：骨肉瘤或直接侵犯骶骨的盆腔癌代表了部分或全骶骨切除术的适应症。目的是描述肿瘤外科治疗和并发症的情况，并分析我们在骶骨切除术后的结果。
方法：在回顾性分析中，包括27例患者（n=8/10/9肉瘤/脊索瘤/局部复发性直肠癌（LRRC））。9例进行了全骶骨切除术（包括。L5组合式脊椎切除术2)，部分切除10例，半球切除8例。在12名患者中，切除是导航辅助.为了重建，网膜成形术,在20、10和13例患者中进行了VRAM皮瓣或脊柱骨盆固定术，分别。
结果：中位随访时间（FU）为15个月，FU率为93%。R0切除81.5%(使用导航没有显著差异)，81.5%的患者患有一种或多种轻度至中度并发症(尤其是伤口愈合障碍/感染)。中位总生存期为70个月。局部复发发生率为20%,而44%的患者发生转移，5例患者死于疾病。
结论：骶骨肿瘤的切除具有挑战性，并且与高并发症有关。与内脏/血管和整形外科的跨学科合作至关重要。在脊索瘤患者中，与LRRC和肉瘤相比，全身肿瘤控制是有利的。导航提供了术中定向的增益，即使目前似乎没有肿瘤益处。完整的手术切除为接受各种复杂疾病的骶骨切除术的患者提供了长期生存。
方法：在回顾性分析中，包括27例患者（n=8/10/9肉瘤/脊索瘤/局部复发性直肠癌（LRRC））。9例进行了全骶骨切除术（包括。L5组合式脊椎切除术2)，部分切除10例，半球切除8例。在12名患者中，切除是导航辅助.为了重建，网膜成形术,在20、10和13例患者中进行了VRAM皮瓣或脊柱骨盆固定术，分别。
结果：中位随访时间（FU）为15个月，FU率为93%。R0切除81.5%(使用导航没有显著差异)，81.5%的患者患有一种或多种轻度至中度并发症(尤其是伤口愈合障碍/感染)。中位总生存期为70个月。局部复发发生率为20%,而44%的患者发生转移，5例患者死于疾病。
结论：骶骨肿瘤的切除具有挑战性，并且与高并发症有关。与内脏/血管和整形外科的跨学科合作至关重要。在脊索瘤患者中，与LRRC和肉瘤相比，全身肿瘤控制是有利的。导航提供了术中定向的增益，即使目前似乎没有肿瘤益处。完整的手术切除为接受各种复杂疾病的骶骨切除术的患者提供了长期生存。
