Outcome of Conservative Surgery for Giant Cell Tumor of the Sacrum

Study Design. Retrospective analysis. Objective. To estimate the clinical outcome of conservative surgery (intralesional curettage or partial excision) aided by effective intraoperative hemorrhage control in patients with giant cell tumors of the sacrum. Summary of Background Data. Giant cell tumors of the sacrum present a challenging therapeutic problem. Wide resection is associated with higher morbidity and spinal instability. Whether conservative surgery aided by effective intraoperative hemorrhage control can achieve low recurrence rates remains uncertain. Methods. The clinical records of 24 patients with an average age of 35 years who had undergone conservative surgery for sacral giant cell tumor between 1996 and 2005 were evaluated retrospectively. The disease onset, tumor size, operation records, complications, follow-up status, and functional outcome were analyzed. Results. The mean duration of follow-up was 58 months (median, 50 months; range: 25-132 months). All the patients had a conservative procedure aided by intraoperative occlusion of the abdominal aorta. The mean estimated blood loss was 3217 mL. The mean length of the operation was 190 minutes. Seven (29.2%) patients developed recurrences. The mean time from the index surgical procedure to the first recurrence was 13 months (range: 8-31 months). The 5-year local recurrence-free survival rate was 69.6%. Seventeen (70.8%) patients retained normal urinary function and 16 (66.7%) patients preserved normal bowel function. No patients had urinary or bowel dysfunction when both S3 nerves were preserved. Ten (41.7%) patients had complications perioperatively or during the follow-up. Seven (29.2%) patients had wound complications. Conclusion. Considering the acceptable local recurrence rate, conservative surgery aided by effective control of intraoperative hemorrhage should be considered as an alternative procedure for patients with giant cell tumors of the sacrum. The advantages include lower morbidity, reduced neurologic deficits, speed and ease of the surgical procedure, reduced blood loss, preservation of spinal and pelvic continuity, and a low recurrence rate.