Maintenance of bowel, bladder, and motor functions after sacrectomy

Moran, Dane; Zadnik, Patricia L.; Taylor, Tessa; Groves, Mari L.; Yurter, Alp; Wolinsky, Jean Paul; Witham, Timothy F.; Bydon, Ali; Gokaslan, Ziya L.; Sciubba, Daniel M.

doi:10.1016/j.spinee.2014.08.445

Cited by 46 publications

(37 citation statements)

References 17 publications

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“…Currently, there is a paucity of studies reporting on patientreported outcomes after treatment for sacral tumors. Studies that do address these outcomes use different tools and use tools that are not completed by the patient, making institutional comparisons increasingly difficult [13,14,19,23,25]. We found that, when comparing patient-reported outcomes based on the sacral nerve roots that were sacrificed, mental and physical health decreased when S3 was bilaterally sacrificed.…”

Section: Discussionmentioning

confidence: 98%

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How Does the Level of Nerve Root Resection in En Bloc Sacrectomy Influence Patient-Reported Outcomes?

Palthe

Houdek

Rose

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background For patients with sacral tumors, who are well enough for surgery, en bloc resection is the preferred treatment. Survival, postoperative complications, and recurrent rates have been described, but patient-reported outcomes often are not included in these studies. Questions/purposes The purposes of this study were (1) to compare patient-reported outcomes after en bloc sacrectomy, based on the level of sacral nerve root resection, in terms of mental health, physical health, bowel function, and sexual function; and (2) to assess differences in terms of mental health, physical health, and pain between patients with and without a colostomy.Methods A total of 74 patients, of whom 58 (78%) were diagnosed with chordoma, were surveyed between February 2012 and October 2014. This represented 48% of patients with sacral chordoma who were alive and who had been treated with a transverse sacral resection between June 2000 and August 2013 at three institutions with a minimum followup of 6 months (mean, 59 months; range, 6-255 months). We chose 6 months because we believe that neurologic deficits generally are stable by this point and that patients generally have recovered from the operation by this time. Patients were divided into five groups based on the most caudal nerve root spared: L5 (N = 10), S1 ( 123Clin Orthop Relat Res (2017) 475:607-616 DOI 10.1007 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® roots were spared (median = 53, IQR = 48-56, q = 0.049). Patients in whom the S2 nerve roots were spared had a slightly lower physical health score (median = 42, IQR = 40-51) than patients in whom the S3 nerve roots were spared (median = 47, IQR = 45-54, q = 0.043). Patients in whom the S1 roots were spared (median = 1.0, range = 1.0-1.0) had a lower orgasm score than patients in whom the S2 nerve roots were spared (median = 3, range = 2-5, q = 0.027). No differences in terms of mental health, physical health, or pain were found between the colostomy group and the no colostomy group. Conclusions The combination of our findings can be used to further educate patients and discuss expectations. In an operative setting, these data can be considered when deciding to place a colostomy. Level of Evidence Level III, therapeutic study.

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Section: Discussionmentioning

confidence: 98%

“…For example, quantitative changes in bowel and bladder function using manometry and cystometry have been reported [8,20]. Other studies based their results on a retrospective review of pre-and postoperative medical records and use dichotomous outcomes [19,25].…”

Section: Introductionmentioning

confidence: 99%

How Does the Level of Nerve Root Resection in En Bloc Sacrectomy Influence Patient-Reported Outcomes?

Palthe

Houdek

Rose

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…However, the degree of function compromised was not accurately described and incontinence and sensation deficit were also not listed in separate items. These limitations were indicated in a later application by Moran et al [31]. Based on Biagini et al's scoring system, a newly designed scoring system was proposed and adopted in the current study aimed at accurately evaluating postoperative function after sacrectomy.…”

Section: Figmentioning

confidence: 98%

“…The overall functional score for sparing unilateral and bilateral S3 was 77% and 85%, respectively. It has been reported that the level of resection in sacrectomy can predict neurological deficit and postoperative function [12,31]. Gunterberg et al [16] performed a neurological evaluation after sacrectomy in 1975.…”

Section: Figmentioning

confidence: 99%

“…It is very important that the surgeons are able to give patients accurate and realistic expectations regarding the surgical results [31]. Although the relationship between the level of sacral amputation and the expected neurological deficit has been studied [31,41], it is hard to accurately anticipate and describe motor, urinary, and bowel function based on the published data. We therefore have proposed-and here, we begin to test-a scoring method to evaluate sacral nerve function after resection of a sacral chordoma.…”

Section: Introductionmentioning

confidence: 99%

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What Are the Conditional Survival and Functional Outcomes After Surgical Treatment of 115 Patients With Sacral Chordoma?

Guo

Yang

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Conditional survival is a measure of prognosis for patients who have already survived for a specific period of time; however, data on conditional survival after sacrectomy in patients with sacral chordoma are lacking. In addition, because sacral tumors are rare and heterogeneous, classifying them in a way that allows physicians to predict functional outcomes after sacrectomy remains a challenge. Questions/purposes (1) What is the overall survival and disease-free survival in patients treated by sacrectomy for chordoma? (2) What is the conditional survival probability and how do prognostic factors change over time in patients undergoing surgical resection for sacral chordoma? (3) What is the local recurrence rate after surgery, how was it treated, and what factors impact on local recurrence? (4) What is the postoperative motor, sensory, bowel, and bladder function by level of resection as determined by using a newly designed scoring method?Methods Between 2003 and 2012, our center treated 122 patients surgically for sacral chordoma. Of those, two died and five were lost before a minimum followup of 1 year was achieved, leaving 115 patients available for analysis in this retrospective study at a mean of 4.9 years (range, 1.3-10.8 years). Basically, single posterior or combined approaches were chosen based on the most cephalad extent of the tumor and resection level was normally at half or one sacral vertebrae above the tumor. The 5-year conditional survival rate was calculated based on Kaplan-Meier survival analysis. The effect of prognostic factors on conditional survival was also explored. A newly designed score method was proposed and adopted in the current study to critically evaluate the functional outcome after resection of the sacrum. Inter-and intraobserver reliability was tested by a preliminary study using kappa statistics and Spearman rank correlation coefficients. Significant interobserver (p\0.01) and intraobserver agreement (j[0.75) were found in nine items between each observer. Results The estimated 5-year overall survival rate was 81% (95% confidence interval [CI], 72%-90%) at diagnosis. The 5-year disease-free survival rate was 52% (95% CI, 43%-63%). The 5-year conditional overall survival decreased with each additional year in the first 4 years (81% at diagnosis versus 60% at the fourth year, p \ 0.0001) and increased slightly in the fifth year. Patients with adequate surgical margins displayed a higher 5-year survival than those with an inadequate margin (86% [95% CI, 76%-95%] versus 67% [95% CI, 48%-85%], p = 0.01) at diagnosis. Conditional survival estimates for patients who received operations elsewhere were lower than that of newly diagnosed patients treated by us at diagnosis (64% [95% CI, 46%-83%] versus 90% [95% CI, 82%-99%], p = 0.012), but with the numbers we had, we could not detect a difference in conditional survival between those treated elsewhere first compared with those initially treated by us at 5 years. The proposed score system for function evaluation was a...

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