RT Journal
A1 Fuchs, Bruno
A1 Dickey, Ian D.
A1 Yaszemski, Michael J.
A1 Inwards, Carrie Y.
A1 Sim, Franklin H.
T1 Operative Management of Sacral Chordoma
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2005
FD October 1
VO 87
IS 10
SP 2211
OP 2216
DO 10.2106/JBJS.D.02693
UL http://dx.doi.org/10.2106/JBJS.D.02693
AB 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.