The Journal of Bone and Joint Surgery (American). 2005;87:2211-2216.
doi:10.2106/JBJS.D.02693
© 2005 The Journal of Bone and Joint Surgery, Inc.
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Operative Management of Sacral Chordoma

Bruno Fuchs, MD, PhD1, Ian D. Dickey, MD2, Michael J. Yaszemski, MD, PhD3, Carrie Y. Inwards, MD3 and Franklin H. Sim, MD3

1 Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
2 Eastern Maine Medical Center, 417 State Street, Suite 209, Bangor, ME 04401
3 Departments of Orthopedics (M.J.Y. and F.H.S.) and Surgical Pathology (C.Y.I.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for F.H. Sim: sim.franklin{at}mayo.edu

Investigation performed at the Departments of Orthopedics and Surgical Pathology, Mayo Clinic, Rochester, Minnesota

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Sacrococcygeal chordoma presents a difficult diagnostic and therapeutic problem, with a high rate of local recurrence. The purpose of this report is to define the importance of adequate surgical treatment for optimum outcome and survival.

Methods: Fifty-two patients underwent surgical treatment for sacrococcygeal chordoma between 1980 and 2001. The series included eighteen female patients and thirty-four male patients, with an average age of fifty-six years (range, thirteen to seventy-six years) at the time of the diagnosis. The surgical approach depended on the level and extent of the lesion, with a posterior approach performed in twenty-two patients and a combined anteroposterior approach used in thirty. A wide surgical margin was achieved in twenty-one patients.

Results: At an average of 7.8 years (range, 2.1 to twenty-three years) postoperatively, twenty-three patients were alive with no evidence of disease. Twenty-three patients (44%) had local recurrence. The rate of recurrence-free survival was 59% at five years and 46% at ten years. The overall survival rates were 74%, 52%, and 47% at five years, ten years, and fifteen years, respectively. The most important predictor of survival was a wide margin. All patients with a wide margin survived, and this survival rate was significantly different from that for patients who had had either marginal or intralesional excision (p = 0.0001). Of the twenty-one patients with a wide margin, seventeen (81%) had undergone a combined anteroposterior approach and only four had been treated with a posterior approach.

Conclusions: A wide surgical margin is the most important predictor of survival and of local recurrence in patients with sacrococcygeal chordoma. Use of a combined anteroposterior approach increases the likelihood of obtaining a wide margin.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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