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Risk Factors for Blood Loss During Sacral Tumor Resection

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Clinical Orthopaedics and Related Research®

Abstract

Extensive hemorrhage is a serious complication during sacral tumor resection. Identifying the risk factors predicting the possibility of extensive hemorrhage would be important to predict which patients would need large amounts of transfused blood intraoperatively and postoperatively and which patients would need blood control by vascular occlusion. We retrospectively reviewed 173 patients who underwent sacral tumor resection performed at our institute between 2003 and 2007. Patients with an estimated total blood loss greater than 3000 mL were classified as having a large amount of blood loss. Sixty-nine (39.88%) patients had blood loss greater than 3000 mL. Male gender, excessive tumor blood supply, tumors involving the S2 body and cephalad to the S2 body, tumor volume greater than 200 cm3, aorta occlusion, surgical approach, reconstruction, and operative time were associated with a large amount of blood loss. Tumors cephalad to the S2-S3 disc space (odds ratio, 3.840), tumor volume greater than 200 cm3 (odds ratio, 3.381), and excessive blood supply (odds ratio, 2.281) independently predicted a large amount of blood loss. Sacral tumors that invaded cephalad to the S2-S3 disc space with a volume greater than 200 cm3 and an excessive blood supply were likely to have a large amount of blood loss during resection.

Level of Evidence: Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Audet IM, Goldhahn RT Jr, Dent TL. Adult sacrococcygeal teratomas. Am Surg. 2000;66:61–65.

    PubMed  CAS  Google Scholar 

  2. Barton PP, Waneck RE, Karnel FJ, Ritschl P, Kramer J, Lecher GL. Embolization of bone metastases. J Vasc Interv Radiol. 1996;7:81–88.

    Article  PubMed  CAS  Google Scholar 

  3. Bergh P, Kindblom LG, Gunterberg B, Remotti F, Ryd W, Meis-Kindblom JM. Prognostic factors in chordoma of the sacrum and mobile spine: a study of 39 patients. Cancer. 2000;88:2122–2134.

    Article  PubMed  CAS  Google Scholar 

  4. Broaddus WC, Grady MS, Delashaw JB Jr, Ferguson RD, Jane JA. Preoperative superselective arteriolar embolization: a new approach to enhance respectability of spinal tumors. Neurosurgery. 1990;27:755–759.

    Article  PubMed  CAS  Google Scholar 

  5. De Cristofaro R, Biagini R, Boriani S, Ricci S, Ruggieri P, Rossi G, Fabbri N, Roversi R. Selective arterial embolization in the treatment of aneurismal bone cyst and angioma of bone. Skeletal Radiol. 1992;21:523–527.

    Article  PubMed  Google Scholar 

  6. Devin C, Chong PY, Holt GE, Feurer I, Gonzalez A, Merchant N, Schwartz HS. Level-adjusted perioperative risk of sacral amputations. J Surg Oncol. 2006;94:203–211.

    Article  PubMed  Google Scholar 

  7. Dickey ID, Hugate RR, Fuchs B, Yaszemski MJ, Sim FH. Reconstruction after total sacrectomy: early experience with a new surgical technique. Clin Orthop Relat Res. 2005;438:42–50.

    Article  PubMed  Google Scholar 

  8. Doita M, Harada T, Iguchi T, Sumi M, Sha H, Yoshiya S, Kurosaka M. Total sacrectomy and reconstruction for sacral tumors. Spine. 2003;28:E296–301.

    Article  PubMed  Google Scholar 

  9. Fourney DR, Rhines LD, Hentschel SJ, Skibber JM, Wolinsky JP, Weber KL, Suki D, Gallia GL, Garonzik I, Gokaslan ZL. En bloc resection of primary sacral tumors: classification of surgical approaches and outcome. J Neurosurg Spine. 2005;3:111–122.

    Article  PubMed  Google Scholar 

  10. Fuchs B, Dickey ID, Yaszemski M, Inwards CY, Sim FH. Operative management of sacral chordoma. J Bone Joint Surg Am. 2005;87:2211–2216.

    Article  PubMed  Google Scholar 

  11. Hugate RR Jr, Dickey ID, Phimolsarnti R, Yaszemski MJ, Sim FH. Mechanical effects of partial sacrectomy: when is reconstruction necessary? Clin Orthop Relat Res. 2006;450:82–88.

    Article  PubMed  Google Scholar 

  12. Keating EM. Current options and approaches for blood management in orthopaedic surgery. J Bone Joint Surg Am. 1998;80:750–762.

    Google Scholar 

  13. Lin CC, Chen PQ, Chen WJ, Chen LH. Prognosis of operative treatment for metastatic hepatocellular carcinoma of the spine. Clin Orthop Relat Res. 2006;444:209–215.

    Article  PubMed  Google Scholar 

  14. Mi C, Lu H, Liu H. Surgical excision of sacral tumors assisted by occluding the abdominal aorta with a balloon dilation catheter: a report of 3 cases. Spine. 2005;30:E614–616.

    Article  PubMed  Google Scholar 

  15. Nakai S, Yoshizawa H, Kobayashi S, Naga K, Ichinose H. Role of autologous blood transfusion in sacral tumor resection: patient selection and recovery after surgery and blood donation. J Orthop Sci. 2000;5:321–327.

    Article  PubMed  CAS  Google Scholar 

  16. Osaka S, Kondoh O, Yoshida Y, Ryu J. Radical excision of malignant sacral tumors using a modified threadwire saw. J Surg Oncol. 2006;93:312–317.

    Article  PubMed  Google Scholar 

  17. Papagelopoulos PJ, Choudhury SN, Frassica FJ, Bond JR, Unni KK, Sim FH. Treatment of aneurysmal bone cysts of the pelvis and sacrum. J Bone Joint Surg Am. 2001;83:1674–1681.

    PubMed  Google Scholar 

  18. Pogoda P, Linhart W, Priemel M, Rueger JM, Amling M. Aneurysmal bone cysts of the sacrum: clinical report and review of the literature. Arch Orthop Trauma Surg. 2003;123:247–251.

    PubMed  Google Scholar 

  19. Prosser GH, Baloch KG, Tillman RM, Carter SR, Grimer RJ. Does curettage without adjuvant therapy provide low recurrence rates in giant-cell tumors of bone? Clin Orthop Relat Res. 2005;435:211–218.

    Article  PubMed  Google Scholar 

  20. Rajkumar SV, Kyle RA. Angiogenesis in multiple myeloma. Semin Oncol. 2001;28:560–564.

    Article  PubMed  CAS  Google Scholar 

  21. Raque GH Jr, Vitaz TW, Shields CB. Treatment of neoplastic diseases of the sacrum. J Surg Oncol. 2001;76:301–307.

    Article  PubMed  Google Scholar 

  22. Sar C, Eralp L. Surgical treatment of primary tumors of the sacrum. Arch Orthop Trauma Surg. 2002;122:148–155.

    Article  PubMed  Google Scholar 

  23. Sung HW, Shu WP, Wang HM, Yuai SY, Tsai YB. Surgical treatment of primary tumors of the sacrum. Clin Orthop Relat Res. 1987;215:91–98.

    PubMed  Google Scholar 

  24. Turcotte RE, Sim FH, Unni KK. Giant cell tumor of the sacrum. Clin Orthop Relat Res. 1993;291:215–221.

    PubMed  Google Scholar 

  25. Wuisman P, Lieshout O, Sugihara S, van Dijk M. Total sacrectomy and reconstruction. Clin Orthop Relat Res. 2000;381:192–203.

    Article  PubMed  Google Scholar 

  26. Zhang L, Gong Q, Xiao H, Tu C, Liu J. Control of blood loss during sacral surgery by aortic balloon occlusion. Anesth Analg. 2007;105:700–703.

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Sainan Zhu for help with statistics in this study.

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Authors and Affiliations

  1. Musculoskeletal Tumor Center, People’s Hospital, Peking University, Beijing, 100044, China

    Xiaodong Tang MD, Wei Guo MD, PhD, Rongli Yang MD, Shun Tang MD & Tao Ji MD

Authors
  1. Xiaodong Tang MD
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  2. Wei Guo MD, PhD
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  3. Rongli Yang MD
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  4. Shun Tang MD
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  5. Tao Ji MD
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Correspondence to Wei Guo MD, PhD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the reporting of these cases and that all investigations were conducted in conformity with the ethical principles of research.

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Tang, X., Guo, W., Yang, R. et al. Risk Factors for Blood Loss During Sacral Tumor Resection. Clin Orthop Relat Res 467, 1599–1604 (2009). https://doi.org/10.1007/s11999-008-0483-1

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  • DOI: https://doi.org/10.1007/s11999-008-0483-1

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