En Bloc Sacrectomy

  • Katsuro Tomita
  • Masahiko Hata
  • Hiroyuki Tsuchiya
  • Hideki Murakami
  • Norio Kawahara

Abstract

Sacral tumors may present a difficult problem to the surgeon who desires to ohtain a clear margin of excision. Frequently, tumors in this anatomical location are of a low grade biologically, such as chordomas or chondrosarcomas, and tllerefore unlikely to result in metastatic disease even though they are locally aggressive. Curative ablation of sacral tumors may be considered difficult hecause of the relationship between the anatomical location of the sacrum and the plexus of the lumbosacral nerves and vessels on the one hand and intrapelvic organs on the other. It is also difficult to reconstruct the continuity between pelvis and spine. However, en bloc sacrectomy may well be oncologically indicated, even for sacral tumors, to reduce the incidence of local tumor recurrence leading to fatal disease. In this chapter, we introduce the surgical classification of sacral tumors and the method of total or partial (segmental) en hloc sacrectomy with a T-saw 1,2

Keywords

Sarcoma Pyramid Osteosarcoma Dura Chondrosarcomas 

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References

  1. 1.
    Tomita K, Kawahara N: The threadwire saw-a new device for cutting bones. J Bone Joint Surg 78A:1915–1917, 1996.Google Scholar
  2. 2.
    Tomita K, Kawahara N, Baba R, et al: Total en bloc spondylectomy for solitary spinal metastases. Int Orthop 18:291–298, 1994.PubMedCrossRefGoogle Scholar
  3. 3.
    Enneking WF: A system of staging musculoskeletal neoplasms. Clin Orthop 204:9–24, 1986.PubMedGoogle Scholar
  4. 4.
    Kaiser TE, et al: Clinicopathologic study of sacrococcygeal chordoma. Cancer 54:2574–2578, 1984.CrossRefGoogle Scholar
  5. 5.
    Gunterberg B, Kewentcr N, Peterson I, et al: Anorectal function after major resections of the sacrum with bilateral or unilateral sacrifice of sacral nerves. Br J Surg 63:546–554, 1976.PubMedCrossRefGoogle Scholar
  6. 6.
    Stener B, Gunterberg B: High amputation of the sacrum for extirpation of tumors, principles and technique. Spine 3:351–366, 1978.PubMedCrossRefGoogle Scholar
  7. 7.
    Shikata J, Yamamuro T, Kotoura Y, et al. Total sacrectomy and reconstruction for primary tumors. J Bone Joint Surg 70A:122–125, 1988.Google Scholar
  8. 8.
    Tomita K, Tsuchiya H: Total sacrectomy and reconstruction for huge sacral tumors. Spine 15:1223–1227,1990.PubMedCrossRefGoogle Scholar
  9. 9.
    Andreoli F, Balloni F, Bigiotti A, et al: Anorectal continence and bladder function. Effects of major sacral resection. Dis Colon Rec 29:647–652, 1986.CrossRefGoogle Scholar
  10. 10.
    Gennari L, Azzarelli A, Quagliuolo V: A posterior approach for the excision of sacral chordoma. J Bone Joint Surg 69:565–568, 1987. Google Scholar
  11. 11.
    Torelli T, Campo B, Ordesi G, et al: Sacral chordoma and rehabilitative treatment of urinary disorders. Tumori 74:475–478, 1988.PubMedGoogle Scholar
  12. 12.
    Gunterberg B, Romanus B, Stener B: Pelvic strength after major amputation of the sacrum. Acta Orthop Scand 47:635–642, 1976.PubMedCrossRefGoogle Scholar
  13. 13.
    Hata M, Kawahara N, Tomita K: Prevention of excessive hemorrhage from venous plexus during total sacrectomy [abstract]. J Jpn Spine Res Soc 8:274, 1997.Google Scholar

Copyright information

© Springer Science+Business Media New York 2003

Authors and Affiliations

  • Katsuro Tomita
  • Masahiko Hata
  • Hiroyuki Tsuchiya
  • Hideki Murakami
  • Norio Kawahara

There are no affiliations available

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