Prognostic Factors in Surgical Resection of Sacral Chordoma

Background and objectives: The best treatment of sacral chordoma is surgical resection, nowadays associated with optimized radiation therapy. We analysed 1) the oncologic outcome in a large series; 2) the effect of previous intralesional surgery, resection level, tumor volume and margins on survivorship to local recurrence (LR) and 3) the complication rate. Methods: We reviewed 71 patients with sacral chordomas. Forty-eight resections were proximal to S3. Mean tumor volume was 535 cm3. Eleven received previous intralesional surgery elsewhere. Margins were wide in 44 resections, wide-contaminated in 11, marginal in 9 and intralesional in 7. Results: Overall survival was 92%, 65% and 44% at 5, 10 and 15 years. At a mean of 9.5 years 37 were NED (54.4%), 23 died with disease (33.8%) and 8 were alive with disease (11.7%). Relapses included 15 LRs, 6 distant metastases, 17 both. LR rate was significantly higher in patients with previous surgery (p = 0.0217), with inadequate margins (p = 0.0339) and large tumors(p< 0.01), whereas resection level was not significant. Multivariate analysis confirmed the role of tumor volume. Complication rate was high (80.9%) with an infection rate of 41.2%. Conclusions: The most prominent adverse factor for LR was previous intralesional surgery. LR rate was related with inadequate margins and tumor volume. (c) 2015 Wiley Periodicals, Inc.