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Sacral Resection

March 01, 2019

Contributors: Michael M Nogler, MD; Hannes Stofferin, MD; Martin Thaler, MD, MSc; Martin Thaler, MD, MSc

Sacral resection is performed to manage malignant sacral tumors. Chordoma is the fourth most common malignant neoplasm originating from bone, occurring in less than 0.1 per 100,000 individuals per year. Chordomas respond poorly to conventional radiotherapy and chemotherapy. Sacrectomy with wide resection margins is the treatment option associated with the best long-term prognosis. This video demonstrates the technique for wide resection in a patient with a chordoma at the S3 vertebral body. Wide resection is performed, with an osteotomy performed at S2. The video shows an anatomic dissection to demonstrate the technique and show the most important anatomic landmarks. The dural sac is ligated beneath the S2 nerve roots. A 2- to 3-cm margin is recommended to prevent contamination of the surrounding tissue. The biopsy tract should be left on the tumor. The video demonstrates a technique sufficient for partial sacrectomy in patients with a malignant sacral tumor. Adequate surgical resection margins are the most important indicator of local disease recurrence and long-term survival in patients who undergo sacrectomy. Tumor infiltration in the area of the sacroiliac joints is associated with an increased risk of disease recurrence. Because of the anatomic vicinity of the internal organs, marginal resection is acceptable anteriorly; however, wide resection margins are mandatory posteriorly and laterally. If all S2 to S5 sacral nerves are sacrificed, 100% of patients will experience abnormal bowel and bladder function. If the S2 sacral nerves are preserved, 25% of patients will maintain bladder function and 40% of patients will maintain bowel function. Therefore, S2 nerve root preservation results in improved quality of life.

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