Operative management of sacral chordoma

Bruno Fuchs, Ian D. Dickey, Michael J. Yaszemski, Carrie Y. Inwards, Franklin H. Sim

Research output: Contribution to journalArticlepeer-review

256 Scopus citations

Abstract

Background: Sacrococcygeal chordoma presents a difficult diagnostic and therapeutic problem, with a high rate of local recurrence. The purpose of this report is to define the importance of adequate surgical treatment for optimum outcome and survival. Methods: Fifty-two patients underwent surgical treatment for sacrococcygeal chordoma between 1980 and 2001. The series included eighteen female patients and thirty-four male patients, with an average age of fifty-six years (range, thirteen to seventy-six years) at the time of the diagnosis. The surgical approach depended on the level and extent of the lesion, with a posterior approach performed in twenty-two patients and a combined anteroposterior approach used in thirty. A wide surgical margin was achieved in twenty-one patients. Results: At an average of 7.8 years (range, 2.1 to twenty-three years) postoperatively, twenty-three patients were alive with no evidence of disease. Twenty-three patients (44%) had local recurrence. The rate of recurrence-free survival was 59% at five years and 46% at ten years. The overall survival rates were 74%, 52%, and 47% at five years, ten years, and fifteen years, respectively. The most important predictor of survival was a wide margin. All patients with a wide margin survived, and this survival rate was significantly different from that for patients who had had either marginal or intralesional excision (p = 0.0001). Of the twenty-one patients with a wide margin, seventeen (81%) had undergone a combined anteroposterior approach and only four had been treated with a posterior approach. Conclusions: A wide surgical margin is the most important predictor of survival and of local recurrence in patients with sacrococcygeal chordoma. Use of a combined anteroposterior approach increases the likelihood of obtaining a wide margin. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)2211-2216
Number of pages6
JournalJournal of Bone and Joint Surgery - Series A
Volume87
Issue number10
DOIs
StatePublished - Oct 1 2005

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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