Complications After Partial, Total or Extended Sacrectomy: A Case Series

Abstract

Objective The aim of this study was to conduct a survey of the different complications of partial, total or extended sacrectomy for the treatment of spinal tumors. Method This study is a descriptive analysis of medical records from a series of 18 patients who underwent sacrectomy between 2010 and 2019 at a tertiary center specializing in spinal tumor surgeries. The variables analyzed were sex, age, hospitalization time, oncologic diagnosis, posterior fixation pattern, rate of complications, and Frankel, ASA and ECOG scales. Results Of the 18 patients, 10 (55.5%) were male and 8 (44.5%) were female, and the mean age was 48 years. The mean hospitalization time was 23 days. Of the 18 patients, 8 (44.5%) contracted postoperative infections requiring surgery. Perioperative complications included liquoric fistula (22.25%), hemodynamic instability requiring vasoactive drugs in the immediate postoperative period (22.25%), wound dehiscence (11.1%), acute obstructive abdomen (11.1%), occlusion of the left external iliac artery (11.1%), immediate postoperative death due to acute myocardial infarction (11.1%), and intraoperative death due to hemodynamic instability (11.1%). Conclusions Partial, total or extended sacrectomy is a complex procedure with high morbidity and mortality, even in centers specializing in the treatment of spinal tumors. Level of evidence IV; case series study.

Partial Sacrectomy in the Management of Sacral Chordoma: Case Report and Literature Review

“…The detailed study of the local anatomy is essential for the success of the procedure and to achieve good functional outcomes. 7 Enneking's principles define wide resection en bloc as the surgical strategy for SCs. 2,5 However, wide resection is a challenge, considering the aggressive behavior of the tumor and its infiltrative nature and poor marginalization.…”

“…Thus, there must be a balance between the chance of recurrence and the maintenance of the neurological function and the integrity of the visceral organs. 2,7 Low sacral amputations (distal to the level of S3) tend to present a minimal deficit, with preservation of almost 100% of the permanent and intestinal function. 6 High sacral amputations and total sacrectomies cause greater spinosacral and sacropelvic instability and sexual and sphincter dysfunction, when S1 is bilaterally injured.…”

“…Among the main complications, we can mention surgical site infection (the most common), wound dehiscence, cerebrospinal fluid (CSF) leak, sacral hernia, and failure in the musculocutaneous reconstruction process. 3,5,7 Radiotherapy (RT) may account for complications in the postoperative period.…”

“…Radiotherapy remains reserved for unresectable patients and incomplete resection margins, considering the surgical possibilities, the presence of associated comorbidities, and the patient's functional status. 5,7 Sacrectomy is a procedure with high morbidity and mortality. 7 The rate of recurrence after surgery is of 40% to 50%, 9 with local recurrence 3 times higher in patients submitted to partial resection when compared to those who underwent total resection.…”

Cordoma sacrococcígeo: revisión del tema

“…The term total sacrectomy refers to resection and attachment of the dural sac below S1, with the resection extending to L4, L5 and to the iliac region if necessary. 33 Total sacrectomy, extended sacrectomy and hemisacrectomy are rare and demanding surgical procedures that cause instability and discontinuity between the spine and pelvis and generate major soft tissue defects. 34 Sacral tumors that lend themselves to en bloc resection can either be approached via a combined or posterior-only approach.…”