Surgical treatment of primary malignant tumors of the sacrum

Varga, Péter Pál and Szövérfi, Zsolt and Lazáry, Áron (2014) Surgical treatment of primary malignant tumors of the sacrum. Neurological Research, 36 (6). pp. 577-587. ISSN 0161-6412

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Abstract

Objectives The objective of the authors was to provide an up-to-date review about the epidemiology, diagnosis and surgical management of the malignant primary sacral tumors. Methods A PubMed search was conducted using a combination of the following items: (("Spinal Neoplasms"[Mesh]) AND "Sacrum"[Mesh]) NOT ("Metastasis" OR "Metastases" OR "Benign"). The literature review and the author's own surgical experiences were used to assess the current treatment strategies of the malignant sacral tumors. Results Twenty case series were identified, which studies discuss in detail the surgical strategies, the postoperative complications, the functional and onclolgic outcome, the recurrence free and the disease specific survival of this rare patient category. Discussion Sacral tumors are rare pathologies. Their management generates a complex medical problem, as they usually are diagnosed in advanced stages with extended dimensions involving the sacral nerves and surrounding organs. The evaluation and complex treatment of these rare tumors require a multidisciplinary approach, optimally at institutions with comprehensive care and experience. Although conventional oncologic therapeutic methods should be used as neoadjuvant or adjuvant therapies in certain histological types, en bloc resection with wide surgical margins is essential for long-term local oncologic control. This is often technically difficult to achieve, as just a few centers in the world perform sacral tumor surgeries on a regular basis, and have enough wide experience. Therefore international cooperation and organization of multicenter tumor registries are essential to develop evidence based treatment protocols.

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