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Operative Management of Sacral Chordoma

Fuchs, Bruno MD, PhD; Dickey, Ian D. MD; Yaszemski, Michael J. MD, PhD; Inwards, Carrie Y. MD; Sim, Franklin H. MD

Journal of Bone & Joint Surgery - American Volume: October 2005 - Volume 87 - Issue 10 - p 2211–2216
doi: 10.2106/JBJS.D.02693
Scientific Articles

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.

1 Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland

2 Eastern Maine Medical Center, 417 State Street, Suite 209, Bangor, ME 04401

3 Departments of Orthopedics (M.J.Y. and F.H.S.) and Surgical Pathology (C.Y.I.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for F.H. Sim: sim.franklin@mayo.edu

Copyright 2005 by The Journal of Bone and Joint Surgery, Incorporated
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