Background: Sacrococcygeal chordoma presents a difficult diagnostic
and therapeutic problem, with a high rate of local recurrence. The purpose of
this report is to define the importance of adequate surgical treatment for
optimum outcome and survival.
Methods: Fifty-two patients underwent surgical treatment for
sacrococcygeal chordoma between 1980 and 2001. The series included eighteen
female patients and thirty-four male patients, with an average age of
fifty-six years (range, thirteen to seventy-six years) at the time of the
diagnosis. The surgical approach depended on the level and extent of the
lesion, with a posterior approach performed in twenty-two patients and a
combined anteroposterior approach used in thirty. A wide surgical margin was
achieved in twenty-one patients.
Results: At an average of 7.8 years (range, 2.1 to twenty-three
years) postoperatively, twenty-three patients were alive with no evidence of
disease. Twenty-three patients (44%) had local recurrence. The rate of
recurrence-free survival was 59% at five years and 46% at ten years. The
overall survival rates were 74%, 52%, and 47% at five years, ten years, and
fifteen years, respectively. The most important predictor of survival was a
wide margin. All patients with a wide margin survived, and this survival rate
was significantly different from that for patients who had had either marginal
or intralesional excision (p = 0.0001). Of the twenty-one patients with a wide
margin, seventeen (81%) had undergone a combined anteroposterior approach and
only four had been treated with a posterior approach.
Conclusions: A wide surgical margin is the most important predictor
of survival and of local recurrence in patients with sacrococcygeal chordoma.
Use of a combined anteroposterior approach increases the likelihood of
obtaining a wide margin.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.