Surgical Treatment And Risk Factors For Recurrence Of Sacral Chordoma

Objective :To study the clinical and functional outcomes resulting from surgical treatment for sacral chordoma.Methods :This retrospective study included 30 cases of sacral chordomas surgically treated in our hospital from January, 1994 to September, 2006. The age of patients ranged from 22 to 73 years (mean 48years), including of 13 male and 17 female. 22 patients had no surgery before they came to our hospital, whereas the other 8 patients had received surgical treatment at least once. All the cases were operated with posterior approach wihtin a day and a half in average after transcatheter arterial embolization with gelfoam. The blood loss and blood transfusion during operation, the drainged blood after operation were reviewed. The sphincter muscle function of bladder and bowl were observed.Results :Tremendous reduction of blood loss during surgery was found in all cases, the blood loss was ranging from 200 ml to 4500 ml (being 1280 ml in average), the blood transfusion was ranging from 0 ml to 4000 ml (being 1080 ml in average), the drainged blood after operation was ranging from 400 ml to 1250 ml (being 650 ml in average). All the cases were followed for an average of 44.6 months (range 6 to 144 months). At the final follow-up, 12 cases recurred (40.0%) and 2 cases died of tumor (6.7%). The sphincter muscle function of bladder and bowl were good in 9 patients whose sacral nerve roots had been reserved at least unilateral S1-3, whereras the function of sphincter muscle impaired in the other 21 patients with sacral nerve roots reserved only at and above S2 level. In one case colostomy and ureterocutaneostomy were used. Conclusion :Preoperative arterial embolization is effective in decreasing intraoperative blood loss and can lead to excellent results. Even if the tumor is relatively huge and the upper resection margin is as high as at S1 or S2 level, the tumor can be removed sucessfully by posterior approach. To resect the tumor and preserve the sacral nerve as possible as we can will probably provided better prognosis for these patients.Partâ…¡Analysis of Risk Factors for Recurrence of Sacral ChordomaObjective :To investigate the factors related with continous diease-free survival time after surgical therapy for sacral chordoma retrospectively, so as to provide theoretic foundation for an improvement of continous diease-free survival time.Methods :This retrospective study included 22 cases of sacral chordomas surgically treated in our hospital for the initial operation from January, 1994 to September, 2006. The data of gender, age, tumor size, tumor location, type of surgery from the initial operation, radiation therapy, recurrence were reviewed. The specimen of 16 cases were immunohistochemically prepared for detection of basic fibroblast growth factor, proliferating cell nuclear antigen. Intensity of expression was graded by using a four-tier system(Grades 1, 2, 3, 4). Continous diease-free survival time was calculated according the Kaplan-Meier method and statistical analysis was performed using Log-Rank test.Results :At the final follow-up, 8 cases recurred (36.4%). All the cases were followed for an average of 38.2 months (range 6 to 144 months). CDFS was found significantly longer in patients whose tumor highest level at and below S3 compared to above S3 (median:58 versus 14 months ,P=0.026), the median CDFS in intralesional surgery group was 22 months, marginal surgery group 44 months and wide surgery group 82 months, Statistic analysis showed that type of surgery from the initial operation was of prognostic significance of CDFS(P=0.003).CDFS was also found significantly longer in PCNA low experssion group as compared to PCNA over experssion group(median:58 versus 22 months, P=0.044), and in bFGF low experssion group as compared to bFGF over experssion group(median:58 versus 22 months ,P=0.030).Conclusion :The high involvement of tumor, over experssion of PCNA, over experssion of bFGF will probably lead to shorter continous diease-free survival time, To resect the tumor as possible as we can will probably provided better prognosis for these patients.