Surgical treatment of primary sacral osteosarcoma

English Keywords:Osteosarcoma  Sacrum  Surgical treatment  Prognosis

English Abstract:

  【Abstract】 Objectives: To evaluate the current surgical therapy of primary sacral osteosarcoma. Methods: From June 2000 to December 2013, 26 patients with primary sacral osteosarcomas underwent surgeries in the department of musculoskeletal tumor, People′s Hospital of Peking University. There were 15 males, 11 females, with a median age of 28 years(12-68 years). Chi-square test was used to compare local recurrence rate between two types of resection(en bloc vs piecemeal resection). Kaplan-Meier method was used to analyze the overall survival rate, and the differences of overall survival rate and progressive free survival rate were compared between two types of resection. Results: Among all 26 patients, 16 cases received en bloc resection while 10 accepted piecemeal resection. The average blood loss was 3435.3±1529.0ml(400-6600ml). The average operation time was 6.8±2.4h(3-12h). No fatal complications occurred during perioperative period. 8 patients were complicated with wound complications and received debridement. 3 patients were complicated with unilateral S3 nerve root injury but could maintain normal bowel and bladder function. 7 cases suffered from unilateral or bilateral S2 nerve root injury and experienced partial bowel and bladder dysfunction, but all gradually improved and could defecate and urinate by themselves. Only 6 cases with unilateral or bilateral S1 nerve root injury needed indwelling catheter, however these cases had bladder function recovered and removed the catheter at about half a year. The patients with bowel dysfunction received no colostomy. 9 cases with bilateral S1 resection had weakness in plantar flexion, but could walk with crutch or foot orthosis. The mean follow-up period was 29.7±19.7 months(6-87 months). 13(50%) patients were diagnosed as metastasis and 10 cases developed local recurrence(5 of 8 patients also had metastasis). The overall survival rate was 92.3%, the 1-year and 5-year survival rate was 38.7%. Patients with en bloc resection had lower local recurrence rate compared with those with piecemeal resection[3/16(18.8%) vs. 7/10(70%), P=0.015] and higher progressive free survival rate(median survival, 19 months vs. 8 months, P=0.04). Conclusions: En bloc resection is superior to piecemeal resection in recurrence control and improving free survival rate. Some cases can achieve long-term survival, though current 5-year survival rate is still low.