Long-Term Survival Following Total Sacrectomy with Reconstruction for the Treatment of Primary Osteosarcoma of the Sacrum. A Case Report*

Spiegel, David A.; Richardson, William J.; Scully, Sean P.; Harrelson, John M.

doi:10.2106/00004623-199906000-00012

Cited by 49 publications

(25 citation statements)

References 35 publications

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“…3,5,7 In recent years, aggressive adjuvant and neoadjuvant chemotherapy has improved the treatment outcome of patients with osteosarcoma. 3,5,8 -11 There have been several articles on the treatment of patients with osteosarcoma of the spine; 3,5,12 however, those publica-tions included patients who were treated over a 30-year or 40-year period under different concepts of treatment 3,5 or were a type of case report 6,[13][14][15][16] because of the rarity of spinal or sacral osteosarcomas.…”

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confidence: 99%

Osteosarcoma of the spine

Ozaki

Flege

Liljenqvist

et al. 2002

Cancer

235

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BACKGROUNDDue to the low incidence rate, the optimal strategy for the treatment of patients with spinal osteosarcoma is unknown.METHODSTwenty‐two patients with osteosarcoma of the spine (15 with tumors of the sacrum and 7 with tumors at other sites) who received chemotherapy according to the Cooperative Osteosarcoma Study Group protocol were analyzed. Six patients presented with metastasis, and 16 patients had no evidence of metastasis at the time of entry into the protocol. Of 12 patients who underwent excision of their tumors, 2 patients underwent wide excision, 3 patients underwent marginal excision, and 7 patients underwent intralesional excision. Eight patients received irradiation: Six patients received conventional radiotherapy only, one patient received neutron beam therapy, and one patient received samarium‐153‐ethylene diamine tetramethylene phosphonate therapy. Follow‐up ranged between 24 months and 105 months (median, 47 months).RESULTSThe median survival was 23 months, and three patients have survived without disease for > 6 years. Patients with primary metastases (P = 0.004), large tumors (P = 0.010), and sacral tumors (P = 0.048) had lower overall survival compared with patients who had no metastasis, small tumors, and nonsacral tumors, respectively. There was a significant difference in overall survival between 5 patients who underwent either wide or marginal surgery and 17 patients who underwent either intralesional surgery or no surgery (P = 0.033). Among 17 patients who underwent no surgery or intralesional surgery, overall survival tended to be better in 7 patients who received irradiation compared with the overall survival in 10 patients who did not receive irradiation (P = 0.059).CONCLUSIONSPatients with metastases, a large tumors, and sacral tumors had a poor prognosis in the current study with small numbers of patients. Wide or marginal excision of the tumor improved survival. Patients with osteosarcoma of the spine should be treated with a combination of chemotherapy and at least marginal excision for those with surgically accessible tumors. Postoperative radiotherapy may be beneficial. Cancer 2002;94:1069–77. © 2002 American Cancer Society.DOI 10.1002/cncr.10258

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confidence: 99%

Osteosarcoma of the spine

Ozaki

Flege

Liljenqvist

et al. 2002

Cancer

235

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“…[45][46][47] Because of the vertical and rotational instability created by the resections, 9,20,38,[41][42][43][44] early mobilization creates substantial shear and places high forces on these reconstructions. 3,43,48 Using cadaveric testing, Gunterberg et al 41 found a 50% decrease in load to failure when the resection included the first sacral body. Using finite element analysis, Kawahara et al 20 found that in the modified Galveston reconstruction, excessive stress concentrations occur within the rod itself, particularly between the L5 pedicle screw and the iliac screw, and not at the bony anchors.…”

Section: Discussionmentioning

confidence: 99%

A Novel “Four-Rod Technique” for Lumbo-Pelvic Reconstruction: Theory and Technical Considerations

Shen

Harper²,

Foster³

et al. 2006

Spine

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“…32 Long-term survival may be feasible in select patients with recurrent metastatic rectal cancer if margin-negative resection is achieved. 12,36 Furthermore, giant cell tumors, 19 primary sacral osteosarcomas, 34 and sacral chordomas 14 have been shown to be amenable to sacral resection, with reports of prolonged survival and functional recovery.…”

Section: Combined Vram and Free Fibular Flapsmentioning

confidence: 99%

Soft-tissue reconstruction after total en bloc sacrectomy

Kim

Pang²,

Christensen³

et al. 2015

SPI

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OBJECT Total en bloc sacrectomy is a dramatic procedure that results in extensive sacral defects. The authors present a series of patients who underwent flap reconstruction after total sacrectomy, report clinical outcomes, and provide a treatment algorithm to guide surgical care of this unique patient population. METHODS After institutional review board approval, data were collected for all patients who underwent total sacrectomy between 2002 and 2012 at The Johns Hopkins Hospital. Variables included demographic data, medical history, tumor characteristics, surgical details, postoperative complications, and clinical outcomes. All subtotal sacrectomies were excluded. RESULTS Between 2002 and 2012, 9 patients underwent total sacrectomy with flap reconstruction. Diagnoses included chordoma (n = 5), osteoblastoma (n = 1), sarcoma (n = 2), and metastatic colon cancer (n = 1). Six patients received gluteus maximus (GM) flaps with a prosthetic rectal sling following a single-stage, posterior sacrectomy. Four required additional paraspinous muscle (PSM) or pedicled latissimus dorsi (LD) fasciocutaneous flaps. Three patients underwent multistage sacrectomy with an anterior-posterior approach, 2 of whom received pedicled vertical rectus abdominis myocutaneous (VRAM) flaps, and 1 of whom received local GM, LD, and PSM flaps. Flap complications included dehiscence (n = 4) and infection (n = 1). During the 1st year of follow-up, 2 of 9 patients (22%) were able to ambulate with an assistive device by the 1st postoperative month, and 6 of 9 (67%) were ambulatory with a walker by the 3rd postoperative month. By postoperative Month 12, 5 of 9 patients (56%)—or 5 of 5 patients not lost to follow-up (100%)—were able to able to ambulate independently. CONCLUSIONS The authors' experience suggests that the GM and pedicled VRAM flaps are reliable options for softtissue reconstruction of total sacrectomy defects. For posterior-only operations, GM flaps with or without a prosthetic rectal sling are generally used. For multistage operations including a laparotomy, the authors consider the pedicled VRAM flap to be the gold standard for simultaneous reconstruction of the pelvic diaphragm and obliteration of dead space.

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Long-Term Survival Following Total Sacrectomy with Reconstruction for the Treatment of Primary Osteosarcoma of the Sacrum. A Case Report*

Cited by 49 publications

References 35 publications

Osteosarcoma of the spine

Osteosarcoma of the spine

A Novel “Four-Rod Technique” for Lumbo-Pelvic Reconstruction: Theory and Technical Considerations

Soft-tissue reconstruction after total en bloc sacrectomy

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