Safety margins in resection of sacral chordoma: analysis of 18 patients.

BACKGROUND: Local recurrence after resection of sacral chordoma is a challenging problem for the orthopedic oncologists. That is why analysis of its margins of safety is of outmost importance. MATERIAL: Eighteen cases of sacral chordoma were retrospectively reviewed. All the patients were followed for determination of their status clinically and radiographically. The surgical margins for every resected tumor were evaluated proximally, ventrally, and at the postero-lateral aspect of the sacrum.
RESULTS: Ventrally, the surgical margins were seven marginal and ten wide margins. Proximally, there were three marginal, nine wide and five curative margins. Postero-laterally, there were one intra-lesional, one marginal, 12 wide and three curative margins. Local recurrence encountered postero-laterally in six cases with five wide and one intra-lesional margin. On the other hand, no local recurrence was disclosed ventrally or proximally despite marginal resections were employed to the ventral resection in seven and proximally in three cases. With a mean follow-up of 11 years, six patients died of their disease, and 12 patients were alive. The 5-, 10- and 15-year survival rates were 81, 70, and 33%, respectively.
CONCLUSIONS: The appropriate surgical margin for complete removal of the chordoma differs according to the location of the tumor and tissues involved. Marginal margin ventrally and wide margin proximally are sufficient while postero-laterally including the gluteus maximus muscles a curative or radical margin seems to be the appropriate surgical margin to prevent tumor recurrence.