The Management of Spinosacropelvic Tumors

Abstract

Curative treatment for many primary tumors of the sacrum requires oncologic sacrectomy. This is an extensive surgical procedure that often involves the lower lumbar spine and ilia and the deliberate sacrifice of neurologic function. Oncologic resections of sacral tumors are challenging because of their proximity to critical vascular, visceral, and neurologic structures, which makes it difficult to obtain a wide margin of resection. The proper resection of large tumors in this area may require a disruption of spinopelvic continuity. The types of tumor most commonly requiring sacrectomy are chordoma, chondrosarcoma, osteosarcoma, malignant peripheral nerve sheath tumors, extradural myxopapillary ependymoma, and recurrent rectal carcinoma without evidence of distant metastases. The magnitude of the surgical procedure for sacrectomy is such that it is generally done only with curative intent, which requires a wide or R0 margin of resection for removal of the entire tumor as a single specimen, without any margins of the specimen showing microscopic evidence of tumor cells. This article describes the factors that merit a consideration of oncologic sacrectomy and the execution of this surgical procedure. Less radical procedures are done for aggressive benign tumors, such as giant-cell tumor and osteoblastoma, or for the treatment of infection. The techniques described in this chapter may be adapted to intralesional resections when indicated.

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