Clinical significance of a wide excision policy for sacrococcygeal chordoma

Osaka, Shunzo; Kodoh, Osamu; Sugita, Hideyuki; Osaka, Eiji; Yoshida, Yoshiyuki; Ryu, Junnosuke

doi:10.1007/s00432-005-0067-3

Cited by 63 publications

(34 citation statements)

References 17 publications

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“…The primary prognostic factor considered is the type of surgical margin attained at initial surgery [5,9,20,29,31,36,50] even when sacrifice of adjacent neurovascular structures is necessary [22][23][24]49]. We therefore (1) confirmed the survival reported previously; and (2) determined the effect of surgical margins, previous intralesional surgery, and level of resection on survivorship to local recurrence.…”

Section: Discussionsupporting

confidence: 58%

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Surgical Margins and Local Control in Resection of Sacral Chordomas

Ruggieri

Angelini

Ussia

et al. 2010

Clinical Orthopaedics &Amp; Related Research

169

152

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Background The treatment of choice in sacral chordoma is surgical resection, although the risk of local recurrence and metastasis remains high. The quality of surgical margins obtained at initial surgery is the primary factor to improve survival reducing the risk of local recurrence, but proximal sacral resections are associated with substantial perioperative morbidity. Questions/purposes We considered survivorship related to local recurrence in terms of surgical margins, level of resection, and previous surgery. Methods We retrospectively reviewed 56 patients with sacral chordomas treated with surgical resection. Thirtyseven were resected above S3 by a combined anterior and posterior approach and 19 at or below S3 by a posterior approach. Nine of these had had previous intralesional surgery elsewhere. The minimum followup was 3 years (mean, 9.5 years; range, 3-28 years). Results Overall survival was 97% at 5 years, 71% at 10 years, and 47% at 15 years. Survivorship to local recurrence was 65% at 5 years and 52% at 10 years. Thirty percent of patients developed metastases. Wide margins were associated with increased survivorship to local recurrence. We found no differences in local recurrence between wide and wide-contaminated margins (that is, if the tumor or its pseudocapsule was exposed intraoperatively, but further tissue was removed to achieve wide margins). Previous intralesional surgery was associated with an increased local recurrence rate. We observed no differences in the recurrence rate in resections above S3 or at and below S3. Conclusions Surgical margins affect the risk of local recurrence. Previous intralesional surgery was associated with a higher rate of local recurrence. Intraoperative contamination did not affect the risk of local recurrence when wide margins were subsequently attained.

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Section: Discussionsupporting

confidence: 58%

“…The surgical margins at initial surgery are the most important factor influencing local recurrence [5,9,20,29,31,36,50]. Resections with wide margins reportedly have a lower local recurrence rate than those with inadequate margins [5,20].…”

Section: Introductionmentioning

confidence: 99%

Surgical Margins and Local Control in Resection of Sacral Chordomas

Ruggieri

Angelini

Ussia

et al. 2010

Clinical Orthopaedics &Amp; Related Research

169

152

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“…Sacral chordomas grow slowly and metastasize late in 20% to 40% of patients, to the lungs, liver, bone, and soft tissues. Ten-year survival ranges from 30% to 65% [3,4,15,16,18,24,31]. Complete surgical excision is a prerequisite to prolonged survival.…”

Section: Introductionmentioning

confidence: 99%

Sacral Chordoma: Can Local Recurrence After Sacrectomy Be Predicted?

Hanna¹,

Aston²,

Briggs³

et al. 2008

Clin Orthop Relat Res

109

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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

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“…According to the literature, almost 17-35% of the patients with chordoma present signs of local recurrence within various period of time after surgery [11,13,20,24]. This can be followed easily or even preceded by distant haemathogenous metastases, with lungs as a predominant site.…”

Section: Discussionmentioning

confidence: 99%

“…Diagnostic certainty is based on histological examination, often suggestive of the diagnosis combined with ultrastructure and immunohistological study [2,16,23]. The clinical course involves local recurrences usually with realistic risk of metastatic development, notably in the sacrococcygeal chordomas case, with its incidence estimated at 17.5% of cases [5,13,24]. Sometimes developing in later stages of their course, histological findings are similar to those of the initial lesion.…”

Section: Introductionmentioning

confidence: 99%

Solitary lymph node metastasis without local recurrence of primary chordoma

et al. 2008

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Chordoma is a malignant neoplasm believed to arise from notochord remnants. Its incidence is highest in the sixth decade and is generally regarded as a locally aggressive tumor with slow progression growth rate. Its metastatic incidence ranges from 5 to 40%, and it is generally believed that metastases without local recurrence of primary neoplasm are extremely rare. We report a case of a 38-year-old male patient with solitary inguinal lymph node metastasis without local recurrence of a previously surgically treated primary sacrococcygeal chordoma.

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Clinical significance of a wide excision policy for sacrococcygeal chordoma

Abstract: Our results suggest that large chordoma should be widely excised, using a modified threadwire saw, with a combination of anterior-posterior procedures.

Cited by 63 publications

References 17 publications

Surgical Margins and Local Control in Resection of Sacral Chordomas

Surgical Margins and Local Control in Resection of Sacral Chordomas

Sacral Chordoma: Can Local Recurrence After Sacrectomy Be Predicted?

Solitary lymph node metastasis without local recurrence of primary chordoma

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