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He S, Bi Y, Ye C, Peng D, Xiao J, Wei H. Interdisciplinary Surgical Treatments and Long-Term Outcomes of Lumbar Spinal Tumors With Retroperitoneal Involvements: A Retrospective Case Series Study. Front Oncol 2022; 11:720432. [PMID: 35004269 PMCID: PMC8733943 DOI: 10.3389/fonc.2021.720432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/23/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Surgical treatments are technically challenging for lumbar spinal tumor (LST) with extensive retroperitoneal involvements. Our study aimed to report the experience and outcomes concerning interdisciplinary surgical collaborations in managing such LSTs. Patients and Methods Nine patients underwent interdisciplinary surgical treatments which were performed by specialists, namely, spinal, vascular, and urinary surgeries. Data on clinical characteristics were collected, and the Visual Analogue Scale (VAS) and the Japanese Orthopaedic Association Score (JOAS) were used in the evaluation before and after surgery. The postoperative complications and the long-term outcomes were reported as well. Results The interdisciplinary work included double J catheter indwelling (n = 9), nephrostomy (n = 5), replacement of the common iliac vein (n = 2), abdominal aorta repair (n = 3), and vital vessel repair (n = 8). The early-stage complications included complaints of moderate low back pain and slight implant shift (n = 1, 11.1%) and tardive ureterodialysis (n = 1, 11.1%). The 3- and 5-year disease-free survival rates were 76.2 ± 14.8 and 50.8 ± 23.0%, respectively, during the mean follow-up of 34.6 ± 17.9 months (range, 9.5–68.7). Besides this, more blood loss was associated with recurrent and metastatic tumor status (p = 0.043) and surgery time >5 h (p = 0.023). Remarkable pain relief and favorable quality of life were achieved based on the postoperative VAS (3.3 ± 0.9, p < 0.001) and JOAS (16.6 ± 0.5, p < 0.001). Conclusions The treatments of LSTs with wide-range retroperitoneal involvements require interdisciplinary surgical collaborations to lower the risks and improve the long-term outcomes. High-quality prospective cohort studies with large samples are warranted to establish general surgical protocols in managing LSTs with extensive retroperitoneal involvements.
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Affiliation(s)
- Shaohui He
- Spinal Tumor Center, Department of Orthopaedic Oncology, No. 905 Hospital of People's Liberation Army (PLA) Navy, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Yifeng Bi
- Spinal Tumor Center, Department of Orthopaedic Oncology, No. 905 Hospital of People's Liberation Army (PLA) Navy, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Chen Ye
- Spinal Tumor Center, Department of Orthopaedic Oncology, No. 905 Hospital of People's Liberation Army (PLA) Navy, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Dongyu Peng
- Spinal Tumor Center, Department of Orthopaedic Oncology, No. 905 Hospital of People's Liberation Army (PLA) Navy, Changzheng Hospital, The Second Military Medical University, Shanghai, China.,Department of Orthopaedic Surgery, Chengdu Military General Hospital, Chengdu, China
| | - Jianru Xiao
- Spinal Tumor Center, Department of Orthopaedic Oncology, No. 905 Hospital of People's Liberation Army (PLA) Navy, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Haifeng Wei
- Spinal Tumor Center, Department of Orthopaedic Oncology, No. 905 Hospital of People's Liberation Army (PLA) Navy, Changzheng Hospital, The Second Military Medical University, Shanghai, China
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Fiani B, Runnels J, Rose A, Kondilis A, Wong A, Musch BL. Clinical manifestations, classification, and surgical management of sacral tumors and the need for personalized approach to sacrectomy. Surg Neurol Int 2021; 12:209. [PMID: 34084636 PMCID: PMC8168693 DOI: 10.25259/sni_133_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/07/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Although comprising 7% of all spinal tumors, sacral tumors present with a litany of issues due to their slow growth and difficulty in detection. As a result, sacral tumors can grow unperturbed for years until a patient presents for an incidental workup of an unassociated minor trauma or an offending primary tumor source that has metastasized to the sacrum; in most cases, this includes primary tumors of the breast, prostate, and lung. The goal of this review is to outline the pathophysiology underlying sacral tumors including the various tissues and structures that can be targeted for treatment, along with a discussion of the surgical approach to sacrectomy. Methods: An extensive review of the published literature was conducted through PubMed database with articles simultaneously containing both search terms “sacral tumors” and “sacrectomy.” No date restrictions were used. Results: The search yielded 245 related articles. Cross-checking of articles was conducted to exclude of duplicate articles. The articles were screened for their full text and English language availability. We finalized those articles pertaining to the topic. Conclusion: Once a sacral tumor has reached the point of diagnostic detection, invasive sacrectomy is typically utilized (through an anterior, posterior, or combination approach) to locally isolate and resect the tumor and minimize risk of future tumor growth and additional bone loss. While institutions have varying criteria for surgical approaches, a combination of anterior and posterior approach has traditionally been used in total and high sacrectomies due to the control it provides surgeons toward the rectum and vasculature anterior to the sacrum. A posterior-only approach can be performed for tumors that failed to invade pelvic organs or extend past the lumbosacral junction. Early detection with screenings can help avoid invasive sacrectomy by identifying the onset of tumor formation in the sacrum, particularly for highly metastatic cancers.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California
| | - Juliana Runnels
- School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Alexander Rose
- School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Athanasios Kondilis
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Amelia Wong
- College of Osteopathic Medicine, Western University of Health Sciences, Pomona, California
| | - Brian L Musch
- College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, United States
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Stabholz Y, Sandhu JS. Management of voiding dysfunction associated with pelvic malignancies. Int J Urol 2020; 28:17-24. [PMID: 33159341 DOI: 10.1111/iju.14405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/14/2020] [Indexed: 11/27/2022]
Abstract
Voiding dysfunction is common after surgical and radiation treatments in patients diagnosed with non-urological pelvic malignancies. Presentation might vary with lower urinary tract symptoms and/or overactive bladder, urinary retention, or incontinence. We reviewed the most recent literature with the aim of describing various types of urinary dysfunction that manifest after radical treatments for non-urological pelvic malignancies. Radical surgical or radiation treatment adversely affect other adjacent pelvic organ function, including viscera, pelvic musculature and the peripheral nervous system. This results in direct organ and indirect functional damage to the genitourinary tract. Multiple surgical and radiation modifications are available nowadays, allowing urologists to offer various treatments for better functional lower urinary tract outcomes. Diagnosing and understanding the type and severity of voiding dysfunction plays a key role in tailoring an appropriate treatment plan. The objective to better functional results relies on maintaining adequate bladder compliance and capacity while permitting volitional emptying, ideally through voiding. Management should routinely start with conservative measures, including pelvic floor muscle training with or without a combination of oral medication for urgency incontinence and clean intermittent catheterization for the management of urinary retention. Concomitant or isolated urinary incontinence can be further managed through multiple established surgical approaches. We attempted to address various treatment available for known lower urinary tract symptoms that might have been caused secondary to non-urological pelvic surgery or radiation. We discuss different diagnostic and treatment modalities individualized for patients with various entities, to help achieve optimal urinary function and improve quality of life.
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Affiliation(s)
- Yariv Stabholz
- Department of Surgery/Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jaspreet S Sandhu
- Department of Surgery/Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Chen H, Xu Q, Zhan P, Liu Y, Dai M, Zhang B. Giant paravertebral schwannoma near the lumbar nerve roots with bone destruction: A case report. Medicine (Baltimore) 2019; 98:e17341. [PMID: 31626091 PMCID: PMC6824752 DOI: 10.1097/md.0000000000017341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Schwannomas grow slowly, originating from the Schwann cells of the nerve sheath. Schwannomas of cranial origin have the highest incidence, followed by intraspinal schwannomas. However, paravertebral schwannoma is rare, and to our knowledge, giant paravertebral schwannomas near the lumbar nerve roots with bone destruction are extremely rare. PATIENT CONCERNS A 47-year-old Chinese woman complained of lower back soreness and a sensation of a bulging lumbar disc with no obvious cause for the past 3 years. DIAGNOSIS Lumbar magnetic resonance imaging showed a large mass with uneven density, 17 × 12 × 15 cm in size, located to the right of the 4th lumbar with obvious bony destruction. Histopathology and immunohistochemistry confirmed that this mass was a benign schwannoma. INTERVENTIONS Complete resection of the tumor (measuring about 17 × 12 × 15 cm in size) and vertebral reconstruction using internal fixation were performed. OUTCOMES The patient was discharged without complications after surgery. The 3-year follow-up revealed that the patient recovered well with no evidence of recurrence. LESSONS Here, we emphasize the importance of careful radiological examination and reflect on the difficulty of tumor resection. Furthermore, understanding the treatment and diagnosis of lumbar paravertebral schwannoma is critical for plastic surgeons and radiologists when encountering similar cases.
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Konovalov NA, Korolishin VA, Asyutin DS, Timonin SY, Martynova MA, Zakirov BA, Batyrov AA. [Complications of surgical treatment of sacral tumors]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 83:67-74. [PMID: 30900689 DOI: 10.17116/neiro20198301167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sacral tumors are a group of neoplasms heterogeneous in the histological type, malignancy, and growth pattern, but with common localization. Surgical treatment of these tumors is associated with the risk of major and minor complications, both during and after surgery. Usually, any surgery aimed at removing tumors in the sacrum or sacral region is associated with the need for reconstruction of bones and/or soft tissues to provide conditions for normal wound healing and the possibility of activating the patient. AIM The study aim was to analyze complications associated with surgery for sacral tumors. MATERIAL AND METHODS The study is based on the experience of surgical treatment of 57 patients with the diagnosis of sacral tumor. The patients underwent 60 surgical interventions related to treatment of the underlying pathology and complications of surgical treatment. Major and minor complications developed in 37 (68%) operated patients. A total of 47 different complications were recorded. In 6 patients, complications in the early postoperative period required additional surgery. CONCLUSION Surgical treatment of sacral tumors is associated with a high risk of complications. Despite the potential risk of major complications, sacrectomy for primary, or potentially aggressive, or malignant neurogenic tumors of the sacrum is necessary to improve local control and survival of patients.
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Affiliation(s)
| | | | - D S Asyutin
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - S Yu Timonin
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - B A Zakirov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A A Batyrov
- Burdenko Neurosurgical Institute, Moscow, Russia
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Konovalov NA, Asyutin DS, Korolishin VA, Kaprovoi SV, Timonin SY, Martynova MA, Zakirov BA, Batyrov AA. [Management of neurogenic tumors of the sacrum and sacral area]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 82:53-58. [PMID: 30721217 DOI: 10.17116/neiro20188206153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tumors of the sacrum rarely occur in routine practice. Due to the absence of pathognomonic symptoms, the diagnosis often becomes apparent at a late disease stage. In this case, the treatment approach depends on the degree of tumor malignancy, growth pattern and location, and relationship between the tumor and the nervous structures, major vessels, and pelvic bones. OBJECTIVE Analysis of the overall and relapse-free survival of patients with neurogenic tumors of the sacrum. MATERIAL AND METHODS In this study, we analyzed the treatment outcomes in 27 patients with neurogenic sacral tumors who underwent surgery at the Burdenko Neurosurgical Institute. RESULTS The median survival time of patients with neurogenic tumors was 72 months; the shortest survival time was observed in a group of neurogenic sarcomas, with the mean survival time being 30 months. Malignant tumors of the peripheral nerves recurred in 100% of cases. CONCLUSION Surgical treatment of neurogenic tumors of the sacrum reduces pain, but does not lead to regression of the neurological symptoms caused by compression of the sacral plexus roots. Patients with malignant tumors of the sacrum should undergo partial or complete sacrectomy. In this case, the choice of treatment strategy should be based on assessment of the functional status, tumor histology, and somatic features of the patient.
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Affiliation(s)
| | - D S Asyutin
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - S V Kaprovoi
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - S Yu Timonin
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - B A Zakirov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A A Batyrov
- Burdenko Neurosurgical Institute, Moscow, Russia
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Paulo D, Semonche A, Tyagi R. Surgical Management of Lumbosacral Giant Invasive Spinal Schwannoma: A Case Report and Literature Review. World Neurosurg 2018; 114:13-21. [DOI: 10.1016/j.wneu.2018.02.146] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/21/2018] [Accepted: 02/23/2018] [Indexed: 11/15/2022]
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Ibrahim T, Farolfi A, Mercatali L, Ricci M, Amadori D. Metastatic Bone Disease in the Era of Bone-Targeted Therapy: Clinical Impact. TUMORI JOURNAL 2018; 99:1-9. [DOI: 10.1177/030089161309900101] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Advances in the diagnosis and treatment of tumors by surgery, chemotherapy, biotherapy, radiotherapy and other modalities have increased the survival of cancer patients over the last 20 years. As a consequence, bone now represents the third most common site of metastatic involvement after the lung and liver. Approximately 20–25% of patients with neoplastic disease develop clinically evident bone metastases (BMs) during the natural course of their illness, with a further 50% of such lesions being identified during autopsy. BMs are the major cause of morbidity in cancer patients because of their epidemiological and clinical impact. Pain is the most frequent symptom in about 75% of patients but other serious complications can also occur, such as pathological fractures, spinal cord compression, hypercalcemia and bone marrow suppression. These complications worsen the patient's general condition and reduce patients’ mobility, facilitating the development of lung infections, skin ulcers, deep vein thrombosis, etc., and ultimately reducing prognosis and quality of life. The frequency of serious complications depends on the site and type of lesions and the treatment administered. Over the last 10 years, the introduction of bisphosphonates for the treatment of patients with BMs has led to a marked decrease in the frequency of complications, thus improving quality of life and clinical outcome. Furthermore, progress in understanding the pathophysiology of bone metastases has resulted in the development of new bone-targeted molecules such as denosumab. We therefore felt it would be useful to report on the epidemiological, clinical and economic impact of bone disease in a cancer setting.
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Affiliation(s)
- Toni Ibrahim
- Osteoncology and Rare Tumors Center, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - Alberto Farolfi
- Osteoncology and Rare Tumors Center, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - Laura Mercatali
- Osteoncology and Rare Tumors Center, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - Marianna Ricci
- Osteoncology and Rare Tumors Center, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - Dino Amadori
- Osteoncology and Rare Tumors Center, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
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Jarvis TR, Xie D, Chi DS, Temple LK, Boland PJ, Sandhu JS. Voiding Dysfunction After Non-genitourinary Radical Pelvic Surgery. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0253-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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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 oncologic outcome, and the recurrence-free and 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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Surgical techniques for spinopelvic reconstruction following total sacrectomy: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23:305-19. [PMID: 24150036 DOI: 10.1007/s00586-013-3075-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 10/12/2013] [Accepted: 10/13/2013] [Indexed: 12/13/2022]
Abstract
PURPOSE To identify all available reconstruction methods for a total sacrectomy. Secondarily, we aimed to evaluate outcomes based on different interventions. METHODS We searched PubMed to identify sacral resections for tumors requiring internal fixation for stabilization. Demographic information, fixation techniques and postoperative outcomes were abstracted. RESULTS Twenty-three publications (43 patients) met inclusion criteria from an initial search of 856 (κ 0.93). Mean age was 37 years and follow-up was 33 months. Fixation methods included a combination of spinopelvic fixation (SPF), posterior pelvic ring fixation (PPRF), and/or anterior spinal column fixation (ASCF). For the purposes of analysis, patients were segregated based on whether they received ASCF. Postoperative complications including wound/instrument infections, GI or vascular complications were reported at a higher rate in the non-ASCF group (1.63 complications/patient vs. 0.7 complications/patient). Instrument failure was seen in 5 (16.1 %) out of the 31 patients with reported outcomes. Specifically, 1 out of 8 patients (12.5 %) with ASCF compared with 4 out of 23 patients (17.4 %) without ASCF had hardware failure. At final follow-up, 35 of 39 patients were ambulating. CONCLUSION While surgical treatment of primary sacral tumors remains a challenge, there have been advances in reconstruction techniques following total sacrectomy. SPF has shifted from intrapelvic rod and hook constructs to pedicle and iliac screw-rod systems for improved rigidity. PPRF and ASCF have adapted for deficiencies in the posterior ring and anterior column. A trend toward a lower rate of hardware failure emerged in the group utilizing anterior spinal column support. Despite a more involved reconstruction with ASCF, surgical complications such as infection rates and blood loss were lower compared to the group without ASCF. While we cannot definitively say one system is superior to the other, based on the data gleaned from this systematic review, it is our opinion that incorporation of ASCF in reconstructing the spinopelvic junction may lead to improved outcomes. However, most importantly, we recommend that the treating surgeon operate on patients requiring a total sacrectomy based on his or her level of comfort, as these cases can be extremely challenging even among experts.
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Feiz-Erfan I, Fox BD, Nader R, Suki D, Chakrabarti I, Mendel E, Gokaslan ZL, Rao G, Rhines LD. Surgical treatment of sacral metastases: indications and results. J Neurosurg Spine 2012; 17:285-91. [PMID: 22900506 DOI: 10.3171/2012.7.spine09351] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Hematogenous metastases to the sacrum can produce significant pain and lead to spinal instability. The object of this study was to evaluate the palliative benefit of surgery in patients with these metastases. METHODS The authors retrospectively reviewed all cases involving patients undergoing surgery for metastatic disease to the sacrum at a single tertiary cancer center between 1993 and 2005. RESULTS Twenty-five patients (21 men, 4 women) were identified as having undergone sacral surgery for hematogenous metastatic disease during the study period. Their median age was 57 years (range 25-71 years). The indications for surgery included palliation of pain (in 24 cases), need for diagnosis (in 1 case), and spinal instability (in 3 cases). The most common primary disease was renal cell carcinoma. Complications occurred in 10 patients (40%). The median overall survival was 11 months (95% CI 5.4-16.6 months). The median time from the initial diagnosis to the diagnosis of metastatic disease in the sacrum was 14 months (95% CI 0.0-29.3 months). The numerical pain scores (scale 0-10) were improved from a median of 8 preoperatively to a median of 3 postoperatively at 90 days, 6 months, and 1 year (p < 0.01). Postoperative modified Frankel grades improved in 8 cases, worsened in 3 (due to disease progression), and remained unchanged in 14 (p = 0.19). Among patients with renal cell carcinoma, the median overall survival was better in those in whom the sacrum was the sole site of metastatic disease than in those with multiple sites of metastatic disease (16 vs 9 months, respectively; p = 0.053). CONCLUSIONS Surgery is effective to palliate pain with acceptable morbidity in patients with metastatic disease to the sacrum. In the subgroup of patients with renal cell carcinoma, those with the sacrum as their solitary site of metastatic disease demonstrated improved survival.
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Affiliation(s)
- Iman Feiz-Erfan
- Department of Neurosurgery, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77230-1402, USA
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Strupas K, Poskus E, Ambrazevicius M. Retrorectal tumours: literature review and vilnius university hospital "santariskiu klinikos" experience of 14 cases. Eur J Med Res 2011; 16:231-6. [PMID: 21719397 PMCID: PMC3352196 DOI: 10.1186/2047-783x-16-5-231] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective Retrorectal tumours are rare lesions in adults. The diagnosis of retrorectal lesion is often difficult and misdiagnosis is common. We present significant number of cases in view of scarce information available on this matter. Methods 14 patients were treated at Vilnius university hospital "Santariskiu klinikos" Centre of abdominal surgery from 1997 to 2010. The case notes of patients who underwent surgery for a retrorectal tumour were reviewed retrospectively. Surgical histories, operations, histological tumour type, surgical time, weight of the specimen, blood loss, length of stay were analysed. Results 13 patients underwent laparotomy, 1 patient had combined perineal approach and laparotomy. The most common types of the tumour were fibroma (3 cases), leiomyosarcoma (2 cases). 5 tumours (35,7%) were found to be malignant. 57% of the patients had undergone at least one operation prior to definitive treatment. 5 female patients were initially admitted under gynaecologists. Hospital stay varied from 14 days to 22 days (mean 16,2 days). A report of a representative case is presented. Conclusions Retrorectal lesions in female patients can mimic gynaecological pathology. Patients with this rare pathology are to be treated in a major tertiary hospital by surgeons, who are able to operate safely in the retrorectal space.
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Affiliation(s)
- Kestutis Strupas
- Vilnius University Hospital, Santariskiu Klinikos, Centre of Abdominal Surgery, Vilnius, Lithuania.
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Davidge KM, Eskicioglu C, Lipa J, Ferguson P, Swallow CJ, Wright FC. Qualitative assessment of patient experiences following sacrectomy. J Surg Oncol 2010; 101:447-50. [PMID: 20401914 DOI: 10.1002/jso.21517] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES The primary objective was to investigate patient experiences following sacral resection as a component of curative surgery for advanced rectal cancers, soft tissue and bone sarcomas. METHODS Qualitative methods were used to examine the experiences, decision-making, quality of life, and supportive care needs of patients undergoing sacrectomy. Patients were identified from two prospective databases between 1999 and 2007. A semi-structured interview guide was generated and piloted. Patient interviews were transcribed verbatim and analyzed using standard qualitative research methodology. Grounded theory guided the generation of the interview guide and analysis. RESULTS Twelve patients were interviewed (6 female, 32-82 years of age). The mean interview time was 34 min. Five themes were identified, including: (1) the life-changing impact of surgery on both patients' and their family's lives, (2) patient satisfaction with immediate care in hospital, (3) significant chronic pain related to sacrectomy, (4) patients' need for additional information regarding long-term recovery, and (5) patients' gratitude to be alive. CONCLUSIONS Sacrectomy is a life-changing event for patients and their families. Patients undergoing sacrectomy need further information regarding the long-term consequences of this procedure. This need should be addressed in both preoperative multi-disciplinary consultations and at follow-up visits.
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Affiliation(s)
- K M Davidge
- Department of Surgery, University of Toronto, The Banting Institute, Toronto, Ontario, Canada.
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Affiliation(s)
- Andreas F Mavrogenis
- First Department of Orthopedics, ATTIKON General University Hospital, Athens University Medical School, Athens, Greece
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Sciubba DM, Petteys RJ, Garces-Ambrossi GL, Noggle JC, McGirt MJ, Wolinsky JP, Witham TF, Gokaslan ZL. Diagnosis and management of sacral tumors. J Neurosurg Spine 2009; 10:244-56. [PMID: 19320585 DOI: 10.3171/2008.12.spine08382] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sacral tumors pose significant challenges to the managing physician from diagnostic and therapeutic perspectives. Although these tumors are often diagnosed at an advanced stage, patients may benefit from good clinical outcomes if an aggressive multidisciplinary approach is used. In this review, the epidemiology, clinical presentation, imaging characteristics, treatment options, and published outcomes are discussed. Special attention is given to the specific anatomical constraints that make tumors in this region of the spine more difficult to effectively manage than those in the mobile portions of the spine.
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Affiliation(s)
- Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland 21287, USA.
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McLoughlin GS, Sciubba DM, Suk I, Witham T, Bydon A, Gokaslan ZL, Wolinsky JP. En Bloc Total Sacrectomy Performed in a Single Stage through a Posterior Approach. Oper Neurosurg (Hagerstown) 2008. [DOI: 10.1227/01.neu.0000312354.43020.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AbstractObjective:Total sacrectomies are performed for extensive en bloctumor resections. Exposure traditionally combines a posterior approach with a laparotomy to facilitate vascular control. We present a case of a total en bloc sacrectomy performed entirely through the posterior approach, thereby avoiding the need for a laparotomy.Clinical Presentation:A 57-year-old man presented with sacral pain and loss of bowel and bladder function. A large sacral mass was identified and submitted to biopsy. Results were consistent with an osteoblastoma, although osteosarcoma could not be excluded on pathological examination. The patient was taken to the operating room for a total sacrectomy and en bloc resection of the mass.Technique:Lateral iliac osteotomies were performed, followed by an L5–S1 discectomy and resection of the annulus, thus mobilizing the sacrum. Gradual distraction of the interspace coupled with upward traction of the sacrum provided an anterior exposure through which the internal iliac vessels were controlled, dissected, and divided. A combined transperineal approach completed the posterior dissection and the tumor was delivered en bloc. Lumbopelvic reconstruction was performed simultaneously.Conclusion:With the use of interspace distraction and sacral elevation to facilitate vascular control, a total sacrectomy was performed without the need for the anterior exposure of a laparotomy.
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Affiliation(s)
- Gregory S. McLoughlin
- Division of Neurosurgery, University of Saskatchewan, Royal University Hospital, Saskatoon, Canada
| | - Daniel M. Sciubba
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland
| | - Ian Suk
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland
| | - Timothy Witham
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland
| | - Ali Bydon
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland
| | - Ziya L. Gokaslan
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland
| | - Jean-Paul Wolinsky
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland
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Abstract
Presacral tumors are rarely found in adults. Resections via open abdominal or sacral approaches have been advocated traditionally as the preferred treatment for these tumors. The endoscopic surgical technique provides direct visualization of the presacral or retroperitoneal space. The authors report on a 67-year-old man who experienced difficulty in defecation off and on for 5 weeks, and recently he had suffered indistinct pain in the lower abdomen. The abdominal computed tomography scan revealed a 5.1 x 4.2-cm, homogeneous, low-density, well-defined mass arising from the left sciatic nerve abutting the left piriformis muscle, favoring a diagnosis of benign neurogenic tumor. Endoscopically guided resection was applied, with a favorable outcome. This procedure represents a less invasive approach that may be useful for benign retroperitoneal pelvic tumors.
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Affiliation(s)
- Chih-Chuan Yang
- Division of Neurosurgery, Changhua Christian Hospital, Changhua, Taiwan, Republic of China.
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