Clinical outcome of intralesional curettage for sacrum giant cell tumor

English Keywords:Giant cell tumors  Sacrum  Intralesional curettage

English Abstract:

  【Abstract】　Objective：To evaluate the surgical outcome of intralesional curettage for sacral giant cell tumor under effective blood control.Method：A total of 43 patients with sacrum giant cell tumor were reviewed retrospectively，of these，35 cases were followed up.There were 18 males and 17 females with the average age of 32 years（range，16-61 years）.The lesion site was noted as S1-S3 in 12 cases，S1-S4 in 9，S1-S5 in 5，S1-S2 in 3，S2-S5 in 2 and S3-S5 in 1 respectively，in addition，3 cases had L5-S1 segments involved.A large soft tissue mass and devoid calcification usually presented in all cases.All patients were treated surgically with intralesional and marginal resection in 31 and wide resection in 4.Of the 35 patients，23 underwent intraoperative blood control by temporary abdominal arterial blockade（artery blocking group），which included 6 tourniquet block of abdominal aorta through anterior approach and 17 balloon occlusion of abdominal aorta introduced from femoral artery under fluoresce guide before operation.The other 12 patients did not receive abdominal aorta blockade（artery unblocking group）.No patients received radiotherapy after operation except one progressing into malignant tumor.All cases were followed up for an average of 37 months（range，12-84 months）.Result：The average blood loss was 3278ml for blocking group and 5150ml for unblocking one，which showed significant difference between two groups （P=0.006）.14 cases（40%） were complicated with postoperative incision problems which resolved after debridement and drainage.7 cases experienced cerebrospinal fluid leakage after operation，which was healed through conventional treatment and intravenous antibiotics.In this study，local recurrence rate was　30.43%（7/23） for blocking group and 66.67%（8/12）for unblocking group，which showed statistical difference between two groups（P=0.03）.Conclusion：Temporary abdominal aorta blockade during the resection of sacral giant cell tumor can effectively reduce operative blood loss and ensure complete tumor removal as well as reducing the local recurrence rate.