En Bloc Sacrectomy

Abstract

Sacral tumors may present a difficult problem to the surgeon who desires to ohtain a clear margin of excision. Frequently, tumors in this anatomical location are of a low grade biologically, such as chordomas or chondrosarcomas, and tllerefore unlikely to result in metastatic disease even though they are locally aggressive. Curative ablation of sacral tumors may be considered difficult hecause of the relationship between the anatomical location of the sacrum and the plexus of the lumbosacral nerves and vessels on the one hand and intrapelvic organs on the other. It is also difficult to reconstruct the continuity between pelvis and spine. However, en bloc sacrectomy may well be oncologically indicated, even for sacral tumors, to reduce the incidence of local tumor recurrence leading to fatal disease. In this chapter, we introduce the surgical classification of sacral tumors and the method of total or partial (segmental) en hloc sacrectomy with a T-saw 1,2