Preservation of the contralateral sacral nerves during hemisacrectomy for sacral malignancies

Abstract

This procedure has an oncologic outcome that is similar to that of other high sacrectomy and a much better function outcome. Although demanding, it is indicated in selected patients.

Hemisacrectomy with preservation of the contralateral sacral nerve roots and sacroiliac joint for pelvic neurofibrosarcoma in a 7-year-old child: case report with 2-year follow-up

“…A 2-stage total hemisacrectomy was planned in a multidisciplinary manner, as previously described. 5,15 The first stage included teams from pediatric surgery, urology, and plastic surgery. A redo midline laparotomy, mobilization of the visceral and neural structures, and reexcision and reestablishment of tumor margins (extirpation of right psoas muscle in contact with the tumor), as confirmed by sampling and frozen pathology, were performed.…”

“…Postoperative urinary and fecal incontinence could lead to an impaired quality of life for the patient, as well as increased health care costs to the individual and to society. 15 In hemisacrectomy with the preservation of contralateral sacral nerve roots, a better quality of life can be expected with conserved bladder and bowel function. To confirm this, we compiled a summary of articles reporting the functional outcomes of patients after total hemisacrectomy involving unilateral sacrifice of sacral nerve roots for the treatment of primary tumors of the sacrum (Table 1).…”

“…Most malignancies originating from the sacrum or pelvis are not sensitive to chemotherapy or radiotherapy, and resection is the mainstay therapy. 5,6,8,15 Sacral malignancies treated with gross-total resection and total sacrectomy sacrifice bilateral sacral nerve roots. Postoperative complications such as urinary and fecal incontinence are therefore inevitable.…”

“…While technically demanding, ensuring a tumor surgical margin may be possible via hemisacrectomy through a sagittal plane in the sacrum without sacrificing the contralateral sacral nerve roots or sacroiliac joint. 15 We performed this procedure on a 7-year-old girl with a new diagnosis of neurofibrosarcoma originating from the right sciatic nerve and involving multiple sacral nerve roots. Herein, we report the tumor resection technique, lumbopelvic reconstruction strategy, and postoperative functional and oncological outcomes at 25 months after surgery.…”

Malignant Pelvic Tumors Involving the Sacrum: Surgical Approaches and Procedures Based on a New Classification

“…P rimary malignant pelvic tumors are frequently asymptomatic at onset and can easily become massive and involve the sacrum [1][2][3] . Achieving adequate margins when resecting pelvic tumors involving the sacrum is often extremely difficult [3][4][5][6][7] ; margins are reportedly inadequate in 26%-54% of tumors invading the sacroiliac joint 2,4,8,9 . As pelvic tumors grow and invade the sacrum, surgical exposure becomes more complex.…”