Background: 

Sacral tumor resections require a multidisciplinary approach to achieve a cure and a functional outcome. Currently, there is no accepted classification system that provides a means to communicate among the multidisciplinary teams in terms of approach, osseous resection, reconstruction, and acceptable functional outcome. The purpose of this study was to report the outcome of sacral tumor resection based on our classification system.

Methods: 

In this study, 196 patients (71 female and 125 male) undergoing an oncologic en bloc sacrectomy were reviewed. The mean age (and standard deviation) was 49 ± 16 years, and the mean body mass index was 27.2 ± 6.4 kg/m². The resections included 130 sarcomas (66%). The mean follow-up was 7 ± 5 years.

Results: 

Resections included total sacrectomy (Type 1A: 20 patients [10%]) requiring reconstruction, subtotal sacrectomy (Type 1B: 5 patients [3%]) requiring reconstruction, subtotal sacrectomy (Type 1C: 104 patients [53%]) not requiring reconstruction, hemisacrectomy (Type 2: 29 patients [15%]), external hemipelvectomy and hemisacrectomy (Type 3: 32 patients [16%]), total sacrectomy and external hemipelvectomy (Type 4: 5 patients [3%]), and hemicorporectomy (Type 5: 1 patient [1%]). The disease-specific survival was 66% at 5 years and 52% at 10 years. Based on the classification, the 5-year disease-specific survival was 34% for Type 1A, 100% for Type 1B, 71% for Type 1C, 65% for Type 2, 57% for Type 3, 100% for Type 4, and 100% for Type 5 (p < 0.001). Tumor recurrence occurred in 67 patients, including isolated local recurrence (14 patients), isolated metastatic disease (31 patients), and combined local and metastatic disease (22 patients). At 5 years, the local recurrence-free survival was 77% and the metastasis-free survival was 68%. Complications occurred in 153 patients (78%), most commonly wound complications (95 patients [48%]). Following the procedure, 154 patients (79%) were ambulatory, and the mean Musculoskeletal Tumor Society (MSTS93) score was 60% ± 23%.

Conclusions: 

Although resections of sacral malignancies are associated with complications, they can be curative in a majority of patients, with a majority of patients ambulatory with an acceptable functional outcome considering the extent of the resection. At our institution, this classification allows for communication between surgical teams and implies a surgical approach, staging, reconstruction, and potential functional outcomes.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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基于新型分类系统的cro骨切除重建效果

背景： 

骨肿瘤切除术需要多学科的方法才能达到治愈和功能性结果。当前，还没有公认的分类系统提供在方法，骨切除，重建和可接受的功能结果方面在多学科团队之间进行交流的手段。这项研究的目的是根据我们的分类系统报告骨肿瘤切除的结果。

方法： 

在这项研究中，对196例（71例女性和125例男性）患者进行了肿瘤整sa手术。平均年龄（和标准差）为49±16岁，平均体重指数为27.2±6.4 kg / m ²。切除包括130例肉瘤（66％）。平均随访时间为7±5年。

结果： 

切除包括需要重建的全sa切除术（1A型：20例患者[10％]），需要重建的全切除sa囊切除术（1B型：5例患者[3％]），不需要重建的全tal膜切除术（1C型：104例患者[53％]） ，半切膜切除术（2型：29例[15％]），外部半截骨切除术和半切膜切除术（3型：32例[16％]），全sa切除术和外部半切膜切除术（4型：5例[3％]）和半体大体切除术5型：1名患者[1％]）。疾病特异性生存率在5年时为66％，在10年时为52％。根据分类，5年疾病特异性生存率：1A型为34％，1B型为100％，1C型为71％，2型为65％，3型为57％，4型为100％。以及类型5的100％（p <0.001）。67例患者发生了肿瘤复发，其中包括局部局部复发（14例），孤立的转移性疾病（31例），以及局部和转移性疾病合并（22例）。5年时，局部无复发生存率为77％，无转移生存率为68％。153例患者发生并发症（78％），最常见的是伤口并发症（95例患者[48％]）。手术后，有154例患者（79％）需门诊，肌肉骨骼肿瘤学会（MSTS93）的平均评分为60％±23％。

结论： 

尽管re骨恶性肿瘤切除术与并发症相关，但在大多数患者中它们可以治愈，考虑到切除的程度，大多数患者可以卧床行走且功能可接受。在我们的机构中​​，这种分类允许外科团队之间的交流，并暗示外科手术方法，分期，重建和潜在的功能结果。

证据级别： 

治疗级别IV。有关证据水平的完整说明，请参见《作者说明》。