Introduction: Bone sarcoma or direct pelvic carcinoma invasion of the sacrum represent indications for partial or total sacrectomy. The aim was to describe the oncosurgical management and complication profile and to analyze our own outcome results following sacrectomy. Methods: In a retrospective analysis, 27 patients (n = 8/10/9 sarcoma/chordoma/locally recurrent rectal cancer (LRRC)) were included. There was total sacrectomy in 9 (incl. combined L5 en bloc spondylectomy in 2), partial in 10 and hemisacrectomy in 8 patients. In 12 patients, resection was navigation-assisted. For reconstruction, an omentoplasty, VRAM-flap or spinopelvic fixation was performed in 20, 10 and 13 patients, respectively. Results: With a median follow-up (FU) of 15 months, the FU rate was 93%. R0-resection was seen in 81.5% (no significant difference using navigation), and 81.5% of patients suffered from one or more minor-to-moderate complications (especially wound-healing disorders/infection). The median overall survival was 70 months. Local recurrence occurred in 20%, while 44% developed metastases and five patients died of disease. Conclusions: Resection of sacral tumors is challenging and associated with a high complication profile. Interdisciplinary cooperation with visceral/vascular and plastic surgery is essential. In chordoma patients, systemic tumor control is favorable compared to LRRC and sarcomas. Navigation offers gain in intraoperative orientation, even if there currently seems to be no oncological benefit. Complete surgical resection offers long-term survival to patients undergoing sacrectomy for a variety of complex diseases.
引言：骶骨部分或全切除术的适应症包括骨肉瘤或盆腔癌直接侵犯骶骨。本研究旨在描述骶骨切除术的肿瘤外科管理及并发症特征，并分析我们自身的治疗结果。方法：通过回顾性分析，共纳入27例患者（肉瘤/脊索瘤/局部复发性直肠癌分别为8/10/9例）。其中全骶骨切除9例（含2例联合L5全椎体切除），部分骶骨切除10例，半骶骨切除8例。12例患者采用导航辅助切除。重建方式包括：20例采用大网膜成形术，10例采用垂直腹直肌肌皮瓣，13例采用脊柱骨盆固定术。结果：中位随访时间为15个月，随访率达93%。R0切除率为81.5%（使用导航辅助无显著差异），81.5%的患者出现一种或多种轻度至中度并发症（尤其是伤口愈合障碍/感染）。中位总生存期为70个月。局部复发率为20%，44%发生远处转移，5例患者死于疾病进展。结论：骶骨肿瘤切除手术难度大，并发症发生率高。与内脏/血管外科及整形外科的跨学科协作至关重要。与局部复发性直肠癌和肉瘤相比，脊索瘤患者的全身肿瘤控制效果更佳。导航技术虽目前未显示肿瘤学获益，但能显著提升术中定位精度。对于多种复杂疾病接受骶骨切除的患者，完整的手术切除可为其提供长期生存机会。
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