How Does the Level of Sacral Resection for Primary Malignant Bone Tumors Affect Physical and Mental Health, Pain, Mobility, Incontinence, and Sexual Function?

Abstract

Background En bloc resection for treatment of sacral tumors is the approach of choice for patients with resectable tumors who are well enough to undergo surgery, and studies describe patient survival, postoperative complications, and recurrence rates associated with this treatment. However, most of these studies do not provide patient-reported functional outcomes other than binary metrics for bowel and bladder function postresection. Questions/purposes The purpose of this study was to use validated patient-reported outcomes tools to compare quality of life based on level of sacral resection in terms of (1) physical and mental health; (2) pain; (3) mobility; and (4) incontinence and sexual function. Methods Our analysis included 33 patients (19 men, 14 women) who had a mean age of 53 years (range, 22-72 years) with a quality-of-life survey administered at a mean postoperative followup of 41 months (range, 6-123 months). The majority of patient-reported quality-of-life outcome surveys for this study were taken from the National Institute of Health's Patient Reported Outcome Measurement Information System (PROMIS) system. To assess physical and mental health, the PROMIS Global Items Survey with physical and mental subscores, Anxiety, and Depression scores were used. Pain outcomes were assessed using PROMIS Pain Intensity and Pain Interference surveys. Patient-reported lower extremity function was assessed using the PROMIS Mobility Survey. Patientreported quality of life for sexual function was assessed using the PROMIS Sex Interest and Orgasm survey, One-way analysis of variance tests on means or ranks were used to conduct statistical analysis between levels. Results Patients with more caudal resections had higher physical health (95% confidence interval [CI] total sacrectomy 36-42 versus S4 50-64, p \ 0.001), less intense pain (95% CI total sacrectomy 47-60 versus S4 28-37, p \ 0.001), less interference resulting from pain (95% CI total sacrectomy 58-69 versus S4 36-51, p = 0.004), higher mobility (95% CI total sacrectomy 24-46 versus S4 59-59, p = 0.002), and were more functionally able to achieve orgasm (95% CI S1 1-1 versus S4 2.2-5.3, p = 0.043).

How Does the Level of Nerve Root Resection in En Bloc Sacrectomy Influence Patient-Reported Outcomes?

“…These results suggest that sacrificing the S3 nerve roots would decrease the patients' physical health. A recent study, using the same questionnaire, showed comparable results for physical health, but not for mental health [22]. Several studies done from a physiological point of view show that the sparing of S3 is necessary for normal function of bowel, bladder function, and sexual function [5,8,9,11,25].…”

“…Patients were divided into five groups based on the most caudal nerve root spared: L5 (N = 10), S1 (N = 22), S2 (N = 17), S3 (N =18), and S4 (N = 7) ( Table 1). All 33 patients (46%) of the preliminary study [22] were used in this study, although the distribution among the study groups is different because of the different study group inclusion criteria (that is, level of bony cut versus nerve roots spared). The operation reports were reviewed retrospectively to identify which nerve roots were resected.…”

CORR Insights®: How Does the Level of Nerve Root Resection in En Bloc Sacrectomy Influence Patient-Reported Outcomes?

“…The authors of the current study recognized the lack of knowledge in the field and have focused on this difficult problem, following previous work [5,8] on patients with metastatic spine disease and assessment of function after sacrectomy based on the level of bone resection. This is unquestionably a novel area of research and their results are quite interesting, despite the usual difficulties with collecting thorough and homogeneous data and maintaining statistical power when analyzing patients' subgroups.…”

What questionnaires to use when measuring quality of life in sacral tumor patients: the updated sacral tumor survey

“…The impact of these major surgeries on neurological, physical, psychological, social, and emotional functioning is substantial and can have a major impact on a patients’ quality of life [7, 27, 31, 36, 44]. It is important to accurately measure these outcomes in order to: (1) understand the impact of treatment on patients, (2) educate future patients, and (3) compare treatments.…”