Surgical treatment of primary tumors of the sacrum.

Fifty-four patients were surgically treated for primary tumors of the sacrum. The ratio of men to women was 2:1, and most patients were from 30-50 years of age. Nearly half the tumors were chordomas, and the others were mostly giant cell tumors and neurofibromas. Proven malignancy was present in less than 10%. The operative and postoperative mortality was 11%, wound infection 11%, delayed wound healing 11%, and the immediate success rate 89%. A follow-up study of 33 cases for more than two years showed that 25 patients were living and well, providing a survival rate of 75.7%. Except for malignant tumors, preservation of upper sacral nerve roots was possible and necessary in the majority of low grade and benign tumors. Ligation of both internal iliac arteries and a temporary block of the common iliac arteries or aorta minimized bleeding. Injury to veins must be carefully avoided. Postoperative X-ray treatment appeared helpful in reducing recurrences, especially in upper sacral tumors where nerve root compression had to be relieved.