Surgical classification and efficacy of sacral side for primary pelvic malignancies involving the sacrum and its therapeutic effect

Abstract

Objective To evaluate the surgical margin achievement,perioperative risk management and improvement in oncologic and functional result of a surgical classification on sacral side for primary pelvic malignancies involving the sacrum.Methods The study was conducted in 59 patients according to modified Enneking type Ⅳ surgical classification in our center from February 2003 to February 2013.There were 28 males and 31 females,with an average of 36 years old (range,15-72 years).There were 43 cases conform to subtype Ⅳa,9 to Ⅳb,5 to Ⅳc and 2 to Ⅳd according to the extent of sacrum the tumor invades.Distinctive resection and reconstruction methods were designed for each subtype.Results Adequate margins were acquired in 43 cases (73％),while inadequate margins were inevitable in 16 cases (27％).Average operation time lasted 5 hours (range,2.5-13 h).Average blood loss during operation was 2 157 ml (range,500-6 000 ml).No case died of perioperative complications.53 of 59 patients were followed up with an average follow-up time of 26 months (range,6-88 months).Local recurrence occurred in 20 cases (38％,20/53),and average recurrence time was 12 months (range,1-52 months).Metastasis occurred in 10 cases.20 patients (38％) were still surviving without recurrence.Average Musculoskeletal Tumor Society 93 score reached 58％.Average score after subtype Ⅳa resection reached 57％ (range,10％-100％),Ⅳb 66％ (range,13％-100％),Ⅳc 45％ (range,13％-77％),and Ⅳ d 30％ (range,27％-33％).Conclusion The modified Enneking's type Ⅳ surgical classification,which is classified as four distinct subtypes according to the extent the sacrum invaded,defines the standardized surgical approach and resection plane.It plays an important role in surgical margin achievement,improvement in oncologic and functional result,and perioperative risk management. Key words: Pelvic tumor; Sacrum; Surgical procedure; Limb salvage