Outcomes of Surgery for Sacral Chordoma and Impact of Complications: A Report of 50 Consecutive Patients With Long-Term Follow-Up

Author:

Zuckerman Scott L.1ORCID,Lee Sun-Ho2,Chang George J.3,Walsh Garrett L.4,Mehran Reza J.4,Gokaslan Ziya L.5,Rao Ganesh6,Tatsui Claudio E.6,Rhines Laurence D.6

Affiliation:

1. Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA

2. Department of Neurological Surgery, Sungkyunkwan University School of Medicine, Seoul, South Korea

3. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

4. Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

5. Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Norman Prince Neurosciences Institute, Providence, RI, USA

6. Department of Neurological Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

Abstract

Study Design: Retrospective case series. Objective: To determine predictive factors of overall survival (OS) and local recurrence (LR), report complications, and assess the impact of complications on survival, recurrence, and function in patients undergoing en bloc resection of sacral chordoma. Methods: This retrospective case series was obtained from a prospective database (1995-2016). All patients underwent en bloc resection of sacral chordoma. Demographic, perioperative, and complication data were collected. Outcomes included: overall survival(OS), local recurrence(LR), and complications. Survival analysis with multivariable cox regression was performed. Results: Among 50 patients, median follow-up was 5.3 years (range = 1.3-17.2). The majority (82%) underwent a negative margin resection. Survival: 17 patients died (34%) with a median OS of 10.0 years (range = 1.3-17.2). Multivariable cox regression revealed that a negative margin resection was not significantly associated with improved survival (HR = 3.35, 95%CI 0.87-12.80, P = .078). Recurrence: 20 patients (40%) experienced LR with a median time of 6.2 years (range = 0-16.9). Multivariable cox regression revealed that a negative margin resection was associated with a significant decreased risk of LR (HR = 4.96, 95%CI 1.84-13.34, P = 0.002,). A 62% overall complication rate was seen (42% major), with 26% reoperation rate. Of the reoperations, 54% were delayed (>6 weeks after the index surgery). Multivariable cox regression demonstrated that neither major complication nor reoperation significantly impacted OS (HR = 0.62, 95%CI 0.22-1.79, P = 0.380), LR (HR = 1.28, 95%CI 0.49-3.36, P = 0.611), or functional outcomes (OR = 2.94, 95%CI 0.25-34.8, P = 0.393). Conclusions: Negative margin resection was associated with decreased LR. Neither major complication nor reoperation significantly impacted OS, LR, or functional outcome. Though additional studies are needed, it appears that despite the morbidity associated with sacral chordoma resection, the long-term clinical outcomes are favorable.

Publisher

SAGE Publications

Subject

Clinical Neurology,Orthopedics and Sports Medicine,Surgery

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