Sharma Rohit, Mukherjee Debashish, Arnav Amiy, Shankaran R, Agarwal Varun Kumar
Department of Surgical Oncology, Army Hospital Research and Referral, Delhi Cantt, 110010 India.
Indian J Surg Oncol. 2021 Dec;12(4):750-758. doi: 10.1007/s13193-021-01471-w. Epub 2021 Nov 19.
Conventional chordomas occur most commonly in the sacral region. Currently, wide local excision remains the only hope for a cure in this disease. However, given the substantial morbidity caused by sacrectomy, a delicate balance needs to be established. This study elaborates our experience in managing these complicated cases with the help of a multidisciplinary team approach and outlines the various surgical and functional outcomes of sacrectomy. This was a retrospective observational study. Ten cases of biopsy proven sacral chordoma underwent en bloc resection by a posterior approach from 2011 to 2018 after multidisciplinary evaluation. Data collected and analyzed included demographics, extent of the disease, and operative parameters such as operative time, estimated blood loss, level of vertebral resection, level and number of the most caudal nerve roots preserved, surgical margins, soft tissue, or spinal reconstruction. Postoperative outcomes included time to recurrence and neurological function at 1 year. Mean size of the tumor was 116.1 mm. Three (30%) patients had positive margins. The median time to recurrence was 32 months. Four patients eventually succumbed to the disease due to local or distant recurrence. Bladder and bowel functions were excellent in those with preserved S3. Two patients remained wheelchair bound; the rest were able to walk with or without support. Management of sacral chordoma remains an onerous journey for both the treating surgeon and the patient. A multidisciplinary team approach, with careful preservation of sacral nerve roots, negative surgical margins, and excellent postoperative rehabilitation, can achieve optimum results.
传统脊索瘤最常发生于骶骨区域。目前，广泛局部切除仍是治愈该病的唯一希望。然而，鉴于骶骨切除术会导致严重的并发症，需要建立一种微妙的平衡。本研究阐述了我们在多学科团队方法的帮助下处理这些复杂病例的经验，并概述了骶骨切除术的各种手术和功能结果。这是一项回顾性观察研究。2011年至2018年，10例经活检证实的骶骨脊索瘤在多学科评估后采用后路整块切除。收集和分析的数据包括人口统计学、疾病范围以及手术参数，如手术时间、估计失血量、椎体切除水平、保留的最尾侧神经根水平和数量、手术切缘、软组织或脊柱重建。术后结果包括复发时间和1年时的神经功能。肿瘤平均大小为116.1毫米。3例（30%）患者切缘阳性。复发的中位时间为32个月。4例患者最终因局部或远处复发而死亡。保留S3的患者膀胱和肠道功能良好。2例患者仍需依赖轮椅；其余患者能够在有或没有支撑的情况下行走。对于治疗外科医生和患者来说，骶骨脊索瘤的治疗仍然是一段艰巨的历程。采用多学科团队方法，仔细保留骶神经根、实现阴性手术切缘并进行出色的术后康复，可取得最佳效果。
