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Case Reports
. 2020 Sep;11(Suppl 1):27-32.
doi: 10.1007/s13193-019-01009-1. Epub 2019 Dec 3.

Total Sacrectomy for the Treatment of Advanced Pelvic Chondrosarcoma

Alvaro Gregorio Morales  1   2 , Jose Luis Garcia Sabrido  1   2 , Jose Antonio Calvo  1   2 , Ruben Perez Mañares  1   2 , Maria Fernandez  1   2 , Jose Manuel Asencio Pacual  1   2
Affiliations
Case Reports

Total Sacrectomy for the Treatment of Advanced Pelvic Chondrosarcoma

Alvaro Gregorio Morales et al. Indian J Surg Oncol. 2020 Sep.

Abstract

Primary tumors of sacrum are rare. The most common malignant tumors are metastasis, and only 6% of all malignant tumors arise from the sacrum. Chondrosarcoma is the third most common primary bone malignancy following myeloma and osteosarcoma. Surgery is usually the most important therapeutic modality; the wide en bloc excision remains the treatment of choice. These technically demanding procedures require a multidisciplinary expert team (neurosurgery, surgical and orthopedic oncology, colorectal surgery, and plastic surgery) involvement. We present in this article a case of a 52-year-old man who presented less infrequent symptoms, and the diagnosis was made in a very advanced stage. The wide surgical excision of the mass was performed by two different anterior and posterior approaches in one stage. The free surgical margins were difficult to achieve because it presented a voluminous tumor with invasion of the rectum, bone, and sacral plexus, but the age, low histological grade, and extensive experience in extreme pelvic surgery of our multidisciplinary team allowed approaching the patient with debulking surgery en bloc, successfully. Total hospital stay was 20 days. The patient was discharged without any complications. At the 6-months' follow-up, the patient showed no local recurrence.

Keywords: Chondrosarcoma; Multidisciplinary; Sacrectomy.

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Figures

Image 1
Image 1
a MRI images show voluminous mass with invasion of the medullary canal (black arrow). b CT shows a great S1 sacral tumor (white arrow). c CT-3D reconstruction of pelvic chondrosarcoma
Image 2
Image 2
The intraoperative photograph, abdominal approach shows the chondrosarcoma tumor, dissection, and vascular control. IVC, inferior vena cava; DA, descending aorta; RCIV, right common iliac vein; LCIV, left common iliac vein; RCIA, right common iliac artery; LCIA, left common iliac artery; RU, right ureter; LU, left ureter
Image 3
Image 3
a, b Photographs of the right transverse rectus abdominis myocutaneous (TRAM) flap performed by the abdominal approach
Image 4
Image 4
Posterior approach, the photographs show the steps of the procedure. a Before the incision. b Total sacrectomy, section and ligation of lumbar plexus roots. c Positioning of the TRAM flap. d Lumbopelvic stabilization was performed with screw fixation technique from L2.
Image 5
Image 5
Postoperative anteroposterior lumbosacral x-ray films showing iliolumbar reconstruction performed
Image 6
Image 6
Tumor specimen, including the full sacrum, the rectal stump, and L5
See this image and copyright information in PMC

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