Surgical strategy for the management of sacral giant cell tumors: a 32-case series

BACKGROUND CONTEXT: Surgical treatment of sacral giant cell tumors (GCTs) is associated with a high rate of complications, and there is controversy over which type of surgical treatment is optimal. PURPOSE: To develop an optimal treatment strategy for sacral GCTs. STUDY DESIGN/SETTING: Retrospective/academic medical center. PATIENT SAMPLE: A total of 32 patients (18 women and 14 men) with sacral GCT who underwent surgery between August 1996 and August 2008. OUTCOME MEASURES: Local recurrence rate, surgical margins, blood loss, sacral nerve root preservation, and complications. METHODS: The medical charts of 32 patients were reviewed. RESULTS: Patients underwent either wide resection (n=2), marginal resection (n=11), marginal resection plus curettage (n=12), or curettage alone (n=7). The curettage group and the wide resection group had the highest and lowest amounts of blood loss (4,500 vs. 1,300 mL, respectively). During follow-up (median, 42 months), 12 patients (37.5%) had local recurrence, including five of seven in the curettage group. The recurrence rate was significantly lower in the marginal excision group compared with that in the curettage group (18.2% vs. 71.4%, respectively; p=.049). Five patients had bladder dysfunction, and two patients had bowel dysfunction. Four patients who underwent marginal resection had lower limb dysfunction. Overall survival was 93.6%, and 2-year recurrence-free survival was 84.4%. CONCLUSIONS: Choosing an optimal surgical margin in the treatment of sacral GCTs is of great importance for local recurrence control and sacral nerve root preservation. Curettage alone should not be used to treat sacral GCT. (c) 2012 Elsevier Inc. All rights reserved.