Paul Manu, Sugath Bhaskar Subin, Mathew Arun Peter, Muralee Madhu, Rao Amrita Balakrishna, Thangaraju Sunil Kumar, Bhargavan Rexeena V, Cherian Kurian, Augustine Paul
Department of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011 India.
Indian J Surg Oncol. 2024 Mar;15(Suppl 1):94-101. doi: 10.1007/s13193-021-01454-x. Epub 2022 Jan 7.
Primary sacral tumors are uncommon and sacrectomy is a complex surgical procedure with substantial risk of morbidity. We conducted a retrospective study of patients who had undergone sacral resections for primary sacral tumors between 2010 and 2020. Ten sacral resections including five type 1 sacrectomy (S1 resected), four type 2 (S1 spared), and one type 3 (S3 spared) were performed during the above period. The median age was 47 years and the most common histologic diagnosis was chordoma (50%). The median operating time was 705 min (range 180-960 min) with a median blood loss of 3400 ml (range 500-7000 ml) and a median duration of hospital stay of 13.5 days (range 7-68 days). All patients who underwent type 1 sacrectomy experienced major complications (Clavien-Dindo grade 3 or above) including one death in the immediate perioperative period. Microscopically positive margins (R1) were noted in two patients (20%). All patients with type 1 sacrectomy had R0 resection. The median follow-up period was 31 months. The median MSTS score was 12 (range 4-27). A total of seven patients (70%) had a minimum follow-up of 2 years without disease recurrence. Sacral resection for primary tumors of the sacrum with oncologically safe margins is feasible. Although associated with substantial perioperative morbidity, a detailed preoperative planning and execution of the surgery by a team of orthopedic oncosurgeon, surgical oncologist, and plastic surgeon offer a hope for survival in patients with acceptable functional outcome.
原发性骶骨肿瘤并不常见，而骶骨切除术是一种复杂的外科手术，具有较高的发病风险。我们对2010年至2020年间因原发性骶骨肿瘤接受骶骨切除术的患者进行了一项回顾性研究。在此期间共进行了10例骶骨切除术，其中包括5例1型骶骨切除术（切除S1）、4例2型（保留S1）和1例3型（保留S3）。中位年龄为47岁，最常见的组织学诊断为脊索瘤（50%）。中位手术时间为705分钟（范围180 - 960分钟），中位失血量为3400毫升（范围500 - 7000毫升），中位住院时间为13.5天（范围7 - 68天）。所有接受1型骶骨切除术的患者均出现了严重并发症（Clavien-Dindo 3级或以上），包括1例围手术期即刻死亡。两名患者（20%）显微镜下切缘阳性（R1）。所有1型骶骨切除术患者均实现了R0切除。中位随访期为31个月。中位MSTS评分为12分（范围4 - 27分）。共有7名患者（70%）至少随访2年无疾病复发。以肿瘤学安全切缘进行骶骨原发性肿瘤的骶骨切除术是可行的。尽管围手术期发病率较高，但由骨科肿瘤外科医生、外科肿瘤学家和整形外科医生团队进行详细的术前规划和手术执行，为功能结局可接受的患者带来了生存希望。
