Patient-Reported Outcomes after Sacral Resection Based on the Level of Nerve Root Resection

Abstract

BACKGROUND CONTEXT: For patients with sacral tumors, who are well enough for surgery, en bloc resection is the preferred treatment. Survival, postoperative complications and recurrent rates are described in the literature. Patient-reported outcomes are often not included in these studies. PURPOSE: The purpose of this study is to compare patient-reported outcomes after en bloc sacrectomy, based on the level of sacral nerve root resection, in terms of mental health, physical health, bowel function and sexual function. STUDY DESIGN/SETTING: Retrospective cohort. PATIENT SAMPLE: Seventy-four patients who underwent transverse sacral resection due to aggresive tumor. OUTCOME MEASURES: National institute of Health's Patient Reported Measurement Information System (PROMIS) Global Health survey, PROMIS Pain interference survey, PROMIS pain intensity survey, PROMIS Sexual Function survey, Modified Obstruction and Defecation Score survey. METHOD(S): Patients were divided into five groups based on the most caudal nerve root spared; L5 (N=10), S1 (N=22), S2 (N=17), S3 (N=18) and S4 (N=7). RESULT(S): A difference in terms of mental health was detected between two adjacent levels, ie, S2 (median=43.5, IQR=41.1'50.8) and the S3 group (median=53.3, IQR=48.3'56.0, Z=-2.3, q=0.049). A difference was found in terms of physical health between two adjacent levels, ie, S2 (median=42.3, IQR=39.8'50.8) and the S3 group (median=47.4, IQR=44.9'54.1, Z=-1.9, q=0.043). Of the sexual function domains, only the orgasm score showed a difference between two adjacent levels, ie, S1 (median=1.0, range=1.0' 1.0) and the S2 group (median=3.0, range=2.0'5.0, Z=-2.5, q=0.027). CONCLUSION(S): Sacrificing the S3 nerve root bilaterally when performing a sacrectomy decreases mental and physical health. Sacrificing the S2 nerve root bilaterally decreases the ability to have an orgasm.