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Weidlich A, Schaser KD, Weitz J, Kirchberg J, Fritzmann J, Reeps C, Schwabe P, Melcher I, Disch A, Dragu A, Winkler D, Mehnert E, Fritzsche H. Surgical and Oncologic Outcome following Sacrectomy for Primary Malignant Bone Tumors and Locally Recurrent Rectal Cancer. Cancers (Basel) 2024; 16:2334. [PMID: 39001396 PMCID: PMC11240444 DOI: 10.3390/cancers16132334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/18/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024] Open
Abstract
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.
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Affiliation(s)
- Anne Weidlich
- University Center for Orthopedics, Trauma Surgery and Plastic Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Klaus-Dieter Schaser
- University Center for Orthopedics, Trauma Surgery and Plastic Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, incl. Division of Vascular and Endovascular Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Johanna Kirchberg
- Department of Visceral, Thoracic and Vascular Surgery, incl. Division of Vascular and Endovascular Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Johannes Fritzmann
- Department of Visceral, Thoracic and Vascular Surgery, incl. Division of Vascular and Endovascular Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Christian Reeps
- Department of Visceral, Thoracic and Vascular Surgery, incl. Division of Vascular and Endovascular Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Philipp Schwabe
- Department for Trauma and Orthopedic Surgery, Center for Musculoskeletal Tumor Medicine, Vivantes Hospital Spandau, 13585 Berlin, Germany
| | - Ingo Melcher
- Department for Trauma and Orthopedic Surgery, Center for Musculoskeletal Tumor Medicine, Vivantes Hospital Spandau, 13585 Berlin, Germany
| | - Alexander Disch
- University Center for Orthopedics, Trauma Surgery and Plastic Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Adrian Dragu
- University Center for Orthopedics, Trauma Surgery and Plastic Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Doreen Winkler
- University Center for Orthopedics, Trauma Surgery and Plastic Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Elisabeth Mehnert
- University Center for Orthopedics, Trauma Surgery and Plastic Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Hagen Fritzsche
- University Center for Orthopedics, Trauma Surgery and Plastic Surgery, Sarcoma Center at the National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, 01307 Dresden, Germany
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Ariyaratne S, Whittaker P, James SL, Botchu R. Comparison of patterns and rates of cement leakage in percutaneous sacroplasty for sacral insufficiency fractures versus neoplasia. Skeletal Radiol 2024; 53:93-98. [PMID: 37301797 DOI: 10.1007/s00256-023-04386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/04/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Percutaneous sacroplasty is a minimally invasive procedure which utilises injection of bone cement into the sacrum for stabilisation of osteoporotic sacral insufficiency fractures (SIF) and neoplastic lesions to relieve pain and improve function. While effective, cement leakage is an important complication associated with the procedure. This study aims to compare the incidence and patterns of the cement leakages following sacroplasty for SIF versus neoplasia and discuss the various patterns of cement leakage and their implications. MATERIALS AND METHODS This retrospective study analysed 57 patients who underwent percutaneous sacroplasty at a tertiary orthopaedic hospital. Patients were divided into 2 groups of SIF (n=46) and neoplastic lesions (n=11) based on their indication for sacroplasty. Pre- and post-procedural CT fluoroscopy was used to assess for cement leakage. The incidence and patterns of cement leakage were both compared among the two groups. A Fisher's exact test was used for statistical analysis. RESULTS Eleven (19%) patients had cement leakage on post-procedural imaging. The most common sites of cement leakage were into the presacral region (6), followed by sacroiliac joints (4), sacral foramina (3) and posterior sacral (1). There was a statistically significant higher incidence of leakage in the neoplastic group in comparison to SIF group (P-value <0.05). The incidence of cement leakage in the neoplastic group was 45% (n = 5/11) versus SIF 13% (n=6/46). CONCLUSION There was a statistically significant higher incidence of cement leak in sacroplasties conducted for the treatment of neoplastic lesions compared to those with sacral insufficiency fracture.
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Affiliation(s)
- S Ariyaratne
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - P Whittaker
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK.
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Tian QH, -Han K, Wang T, Min DL, Wu CG. Percutaneous Sacroplasty with or without Radiofrequency Ablation for Treatment of Painful Sacral Metastases. AJNR Am J Neuroradiol 2022; 43:1222-1227. [PMID: 35863777 PMCID: PMC9575424 DOI: 10.3174/ajnr.a7587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/07/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Percutaneous sacroplasty is a variation of percutaneous vertebroplasty that has gained attention as a therapeutic option for patients with painful sacral insufficiency fractures due to osteoporosis or metastases. Additionally, percutaneous sacroplasty can also be used to treat painful sacral metastases without a pathologic fracture. The purpose of this retrospective study was to compare the efficacy and safety of fluoroscopy-guided percutaneous sacroplasty alone versus percutaneous sacroplasty plus radiofrequency ablation for the treatment of painful sacral metastases. MATERIALS AND METHODS For this retrospective study, 126 patients (with a total of 162 painful sacral metastases) were enrolled from October 2012 to February 2021 and assigned to receive either percutaneous sacroplasty plus radiofrequency ablation (n = 51, group A) or percutaneous sacroplasty alone (n = 75, group B). Four different approaches were used for percutaneous sacroplasty: transiliac, interpedicular, anterior-oblique, and posterior. The Visual Analog Scale, Oswestry Disability Index, and Karnofsky Performance Scale were used to evaluate outcomes. RESULTS The Visual Analog Scale, Oswestry Disability Index, and Karnofsky Performance Scale scores showed significant improvement in both groups after treatment (P < .05). The overall pain relief rate was significantly better in group A than in group B (90% versus 76%, P = .032). There were no significant differences in the incidence of polymethylmethacrylate leakage between the 2 groups or among the 4 different approaches (P > .05). CONCLUSIONS Both percutaneous sacroplasty alone and the combination of percutaneous sacroplasty and radiofrequency ablation are safe and effective for treatment of painful sacral metastases. The combination of percutaneous sacroplasty and radiofrequency ablation appears to be more effective than percutaneous sacroplasty alone.
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Affiliation(s)
- Q-H Tian
- From the Departments of Diagnostic and Interventional Radiology (Q.-H.T., T.W., C.-G.W.)
| | - K -Han
- Oncology (K.-H., D.-L.M.), Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - T Wang
- From the Departments of Diagnostic and Interventional Radiology (Q.-H.T., T.W., C.-G.W.)
| | - D-L Min
- Oncology (K.-H., D.-L.M.), Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - C-G Wu
- From the Departments of Diagnostic and Interventional Radiology (Q.-H.T., T.W., C.-G.W.)
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Treatment, Outcome, and Relapse of Spontaneous and Nonspontaneous Cerebrospinal Fluid Leak. Brain Sci 2022; 12:brainsci12030340. [PMID: 35326296 PMCID: PMC8945904 DOI: 10.3390/brainsci12030340] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/22/2022] [Accepted: 02/27/2022] [Indexed: 02/05/2023] Open
Abstract
Cerebrospinal fluid (CSF) leak can be spontaneous or nonspontaneous. The management options include conservative treatments, blood patch, and surgical repairs. We compared clinical symptoms, image findings, management options, hospitalization, and relapse rates among different causes of CSF leaks. Eighty-one patients were recruited: 20 with spontaneous and 61 with nonspontaneous CSF leaks. Nonspontaneous causes included lumbar puncture, surgery, and trauma. Surgery sites comprised sphenoid, spine, skull base, and calvaria. Spontaneous CSF leak came from the sphenoid or spine. Age, gender, body mass index, initial symptoms, hospitalization, treatment courses, and recurrence rates showed no difference between the groups. The spontaneous group had higher CSF accumulations on their MRIs. MRI pachymeninge enhancement showed the highest sensitivity (78.6%) for intracranial hypotension. Meningitis occurred in 1/3 of sphenoid, skull base, and calvarian surgeries. Earlier reoperation was correlated with shorter hospitalization (r = 0.651), but the recurrence rates were similar. Longer intervals between surgery and CSF leak encouraged reoperation. Among the spontaneous spine and lumbar puncture-related CSF leaks, 57.1% of them responded to 4 days of conservative treatment. Among the trauma-related CSF leaks, 90.9% of them required surgical repair. The demographic data and symptoms were similar in various groups of CSF leak. The symptom onset durations and treatment strategies were different. However, the recurrence rates were similar.
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