The surgical management of sacrococcygeal chordoma

Yonemoto, Tsukasa; Tatezaki, Shin-ichiro; Takenouchi, Toshinao; Ishii, Takeshi; Satoh, Tetsuzo; Moriya, Hideshige

doi:10.1002/(sici)1097-0142(19990215)85:4<878::aid-cncr15>3.0.co;2-7

Cited by 131 publications

(93 citation statements)

References 14 publications

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“…This may be explained by the presence of the presacral fascia anterior to the sacrum, which seems to prevent tumor cells from going beyond it [31]. Yonemoto et al concluded a less radical anterior margin is acceptable, whereas a wide posterior margin is crucial for local disease control [31]. We found the presence of muscle and/or sacroiliac joint involvement increased the tendency of recurrence, even after wide excision of the tumor.…”

Section: Discussionmentioning

confidence: 74%

“…All the local recurrences in our patients occurred in the soft tissues posterior to the sacrum, whereas no recurrences were observed in the anterior region. This may be explained by the presence of the presacral fascia anterior to the sacrum, which seems to prevent tumor cells from going beyond it [31]. Yonemoto et al concluded a less radical anterior margin is acceptable, whereas a wide posterior margin is crucial for local disease control [31].…”

Section: Discussionmentioning

confidence: 99%

“…Sacral chordomas grow slowly and metastasize late in 20% to 40% of patients, to the lungs, liver, bone, and soft tissues. Ten-year survival ranges from 30% to 65% [3,4,15,16,18,24,31]. Complete surgical excision is a prerequisite to prolonged survival.…”

Section: Introductionmentioning

confidence: 99%

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Sacral Chordoma: Can Local Recurrence After Sacrectomy Be Predicted?

Hanna¹,

Aston²,

Briggs³

et al. 2008

Clin Orthop Relat Res

109

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Surgical resection margins are reportedly the most important predictor of survival and local recurrence with sacral chordomas. We examined the relevance of invasion of the surrounding posterior pelvic musculature (piriformis and gluteus maximus) at initial diagnosis to local recurrence after sacrectomy. We retrospectively reviewed 18 patients with histologically verified sacral chordoma seen at our institution between 1998 and 2005. There were 14 men and four women with a mean age of 65.1 years (range, 31-78 years). The average overall followup was 4.4 years (range, 0.5-10 years), 5.4 years for the living patients (range, 3-10 years), and 2.8 years for the deceased (range, 0.5-5.4 years). Local recurrence occurred in 12 patients (66%) 29 months postoperatively (range, 2-84 months

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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Sacral Chordoma: Can Local Recurrence After Sacrectomy Be Predicted?

Hanna¹,

Aston²,

Briggs³

et al. 2008

Clin Orthop Relat Res

109

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“…Previous clinical series have demonstrated that a negative surgical margin is the single most important predictor of tumor recurrence and long-term survival [13,43]. Tumors with more proximal involvement necessitating total or subtotal sacrectomy pose the greatest management challenges as a result of the conflict between achieving a wide surgical margin and sacral nerve preservation [12,13,24,43].…”

Section: Discussionmentioning

confidence: 99%

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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“…Earlier studies have shown mixed results regarding the ability of radiotherapy to improve the prognosis when the surgical margin is positive. 5,17,18 Some technologies such as protons or intensity modulated radiationtherapy have been used to improve the radiobiological effect. 19 However, our results did not show that radiation therapy improved CDFS.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors of sacral chordoma after surgical therapy: a study of 36 patients

et al. 2009

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Study design: Retrospective study. Objectives: To investigate prognostic factors of sacral chordomas and provide theoretical foundation for an improvement of continuous disease-free survival (CDFS). Methods: Thirty-six patients underwent initial operation for sacral chordoma between 1992 and 2007. Data regarding age, gender, tumor size, tumor location, and type of surgery, surgical margins, surrounding muscle invasion, radiation therapy, and recurrences were reviewed and analyzed statistically. Results: The average duration of follow-up was 74.4 months (range, 16-182 months). Sixteen patients developed local recurrences at the time of final follow-up. The average recurrence time was 30 months (range, 3-84 months). The 5-year and 10-year actuarial CDFS were 59.5 and 42%, respectively. CDFS was found statistically longer in patients whose tumor highest level at or below S3 compared with above S3 (P ¼ 0.047). Patients who had invasion into the surrounding muscle had a shorter CDFS than those without surrounding muscle invasion (P ¼ 0.014). Statistic analysis showed that the type of surgery was the most valuable indicator of CDFS (P ¼ 0.001). The local recurrence rate was statistically higher when an inadequate margin has been achieved (P ¼ 0.021). The Cox multivariate regression analysis showed that surrounding muscle invasion (P ¼ 0.024) was an independent adverse prognostic factor for CDFS, whereas incomplete excision (P ¼ 0.056) achieved borderline significance. Conclusions: The higher level of tumor involvement, invasion into the surrounding muscle, incomplete excision, and inadequate surgical margins are poor prognostic factors. Resecting the tumor completely with wide surgical margins may provide a better prognosis for these patients.

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The surgical management of sacrococcygeal chordoma

Cited by 131 publications

References 14 publications

Sacral Chordoma: Can Local Recurrence After Sacrectomy Be Predicted?

Sacral Chordoma: Can Local Recurrence After Sacrectomy Be Predicted?

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

Prognostic factors of sacral chordoma after surgical therapy: a study of 36 patients

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