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01.09.2008 | Original Article | Ausgabe 9/2008

Clinical Orthopaedics and Related Research® 9/2008

Sacral Chordoma: Can Local Recurrence After Sacrectomy Be Predicted?

Zeitschrift:
Clinical Orthopaedics and Related Research® > Ausgabe 9/2008
Autoren:
MRCS S. A. Hanna, FRCS (Orth) W. J. S. Aston, MCh (Orth), FRCS T. W. R. Briggs, MCh (Orth), FRCS S. R. Cannon, MRCP, FRCR A. Saifuddin
Wichtige Hinweise
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and informed consent for participating in the study was obtained.

Abstract

Surgical resection margins are reportedly the most important predictor of survival and local recurrence with sacral chordomas. We examined the relevance of invasion of the surrounding posterior pelvic musculature (piriformis and gluteus maximus) at initial diagnosis to local recurrence after sacrectomy. We retrospectively reviewed 18 patients with histologically verified sacral chordoma seen at our institution between 1998 and 2005. There were 14 men and four women with a mean age of 65.1 years (range, 31–78 years). The average overall followup was 4.4 years (range, 0.5–10 years), 5.4 years for the living patients (range, 3–10 years), and 2.8 years for the deceased (range, 0.5–5.4 years). Local recurrence occurred in 12 patients (66%) 29 months postoperatively (range, 2–84 months). Six of these patients had wide excisions at initial surgery, five had marginal excisions, and one had an intralesional excision. Ten patients had wide surgical margins, six of whom (60%) had local recurrences. Tumor invasion of adjacent muscles at presentation was present in 14 patients, 12 of whom (85%) had local recurrences. Sacroiliac joint involvement was seen in 10 patients, nine of whom (90%) had local recurrences. The findings suggest obtaining wide surgical margins posteriorly, by excising parts of the piriformis, gluteus maximus, and sacroiliac joints, may result in better local disease control in patients with sacral chordoma.
Level of Evidence: Level IV, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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