The surgical management of sacrococcygeal chordoma

Abstract

It is highly possible that residual chordoma infiltrating the gluteal muscles accounts mainly for the local recurrences. Therefore, a precise preoperative assessment of the tumor infiltration into the gluteal muscles by magnetic resonance imaging is important for the prevention of local recurrence. For complete tumor removal, a radical wide posterior surgical margin of the gluteal muscles should be employed. A less radical anterior surgical margin is sufficient because there is a firm presacral fascia anterior to the sacrum. The appropriate surgical margin for the complete removal of the chordoma differs according to the location of the tumor and tissues involved.

Clinical significance of a wide excision policy for sacrococcygeal chordoma

“…The overall survival rates were 83.3% at 5 years, and 55.6% at 10 and 20 years. These long-term survival rates are better than those previously reported for patients who have undergone radical excision (Samson et al 1993;Yonemoto et al 1999).…”

Clinical Outcome of Sacral Chordoma With Carbon Ion Radiotherapy Compared With Surgery

“…The occurrence of distant metastases in the published data has ranged from 5% to 40% and is generally more delayed than the occurrence of local relapse (18,21,26,30). Local recurrence is of great concern because of its inverse relationship with survival (17)(18)(19)(20).…”

Effect of Carbon Ion Radiotherapy for Sacral Chordoma: Results of Phase I-II and Phase II Clinical Trials

“…Complete resection contributes to a good local control rate and prolongation of the disease-free survival (4)(5)(6)(7)(8). Local control rates have approached 60-80% for total excision cases compared with 25-50% after subtotal resection (4, 5, 7).…”

“…They are not easy to control because of their anatomic location and propensity for spreading extensively. Although complete radical resection produces longer continuous local control and an extended disease-free period compared with subtotal resection (4)(5)(6)(7)(8), by the time the symptoms first appear, chordomas are often already too large for complete excision to be possible (9,10). Thus, despite being a low-grade malignancy, sacral chordomas have a low long-term local control rate (6,7).…”