Total Sacrectomy for the Treatment of Advanced Pelvic Chondrosarcoma
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CASE REPORT
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 Received: 14 April 2019 / Accepted: 6 November 2019 # Indian Association of Surgical Oncology 2019
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 6months’ follow-up, the patient showed no local recurrence. Keywords Chondrosarcoma . Sacrectomy . Multidisciplinary
Introduction Primary tumors of sacrum are rare. The most common malignant tumors are metastasis, and only 6% of all malignant tumors arise from the sacrum [1]. Chondrosarcoma is the third most common primary bone malignancy following myeloma and osteosarcoma [2, 3]. Chondrosarcomas constitute a heterogeneous group of bone malignant neoplasms that have in common the production of chondroid [2, 3]. They occur predominantly in elderly
* Alvaro Gregorio Morales [email protected] 1
Universidad Complutense de Madrid, Madrid, Spain
2
Hospital General y Universitario Gregorio Marañon, Madrid, Spain
patients with a peak incidence in the sixth decade, and have a predilection for the shoulders, pelvis, proximal femur, and rib, and rarely involve the sacrum [1, 3, 4]. The clinical behavior is variable; 90% are conventional chondrosarcoma of low and intermediate grade [5]. Although the majorities of these tumors have a slow growth rate, rarely metastasize, and have a very good prognosis after surgery, local recurrence is quite common, especially following inadequate excision [5, 6]. Wide experience in the treatment of other tumors showed the role of IOERT in the control of local recurrence [7]. On the other hand, high-grade chondrosarcoma (5– 10%) and some rare variants have high potential metastatic and poor prognosis after resection
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