The surgical management of sacral chordoma
To analyze the surgical treatment results and experience of sacral chordoma. The data of 51 cases of sacral chordoma surgically treated from July 1997 to July 2007 was retrospectively studied. The age of patients ranged from 21 to 75 years (mean 57 years), including 32 males and 19 females. Forty patients had the first surgery, while other 11 patients were referred to our hospital because of local recurrence from other hospital. Wide resection for all 17 S(3-5) tumors, and wide resection plus piece-meal excision for 34 tumors which involved S(3) above. Reconstruction was performed using pedicle screw and rod device to achieve the continuity between the lumbar spine and the pelvis. The oncologic and functional outcomes of 51 patients were reviewed. After a mean duration of follow-up of 3.5 years (range from 15 to 108 months), 5 of 51 patients died of disease. Seventeen of 40 (42.5%) patients who underwent first surgery recurred during follow-up, 18 of 28 patients (64.3%) got re-relapse after second or third surgeries. Postoperative wound complications were as high as 31.6%. Chordoma is a biologically aggressive low-grade malignant tumor. Wide resection is a prerequisite for curative treatment of sacrococcygeal chordoma, intralesional curettage causes the risk of high local recurrence for which curative resection in a second or third procedure is more difficult to achieve. In order to preserve near normal bowel and bladder function for the tumor which involves S(3) above, wide en-bloc resection plus piece-meal excision in the cephalad is performed.