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

Abstract

Background For patients with sacral tumors, who are well enough for surgery, en bloc resection is the preferred treatment. Survival, postoperative complications, and recurrent rates have been described, but patient-reported outcomes often are not included in these studies. Questions/purposes The purposes of this study were (1) to compare patient-reported outcomes after en bloc sacrectomy, based on the level of sacral nerve root resection, in terms of mental health, physical health, bowel function, and sexual function; and (2) to assess differences in terms of mental health, physical health, and pain between patients with and without a colostomy.Methods A total of 74 patients, of whom 58 (78%) were diagnosed with chordoma, were surveyed between February 2012 and October 2014. This represented 48% of patients with sacral chordoma who were alive and who had been treated with a transverse sacral resection between June 2000 and August 2013 at three institutions with a minimum followup of 6 months (mean, 59 months; range, 6-255 months). We chose 6 months because we believe that neurologic deficits generally are stable by this point and that patients generally have recovered from the operation by this time. Patients were divided into five groups based on the most caudal nerve root spared: L5 (N = 10), S1 ( 123Clin Orthop Relat Res (2017) 475:607-616 DOI 10.1007 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® roots were spared (median = 53, IQR = 48-56, q = 0.049). Patients in whom the S2 nerve roots were spared had a slightly lower physical health score (median = 42, IQR = 40-51) than patients in whom the S3 nerve roots were spared (median = 47, IQR = 45-54, q = 0.043). Patients in whom the S1 roots were spared (median = 1.0, range = 1.0-1.0) had a lower orgasm score than patients in whom the S2 nerve roots were spared (median = 3, range = 2-5, q = 0.027). No differences in terms of mental health, physical health, or pain were found between the colostomy group and the no colostomy group. Conclusions The combination of our findings can be used to further educate patients and discuss expectations. In an operative setting, these data can be considered when deciding to place a colostomy. Level of Evidence Level III, therapeutic study.

One‐Step Reconstruction with a Novel Suspended, Modular, and 3D‐Printed Total Sacral Implant Resection of Sacral Giant Cell Tumor with Preservation of Bilateral S1–3 Nerve Roots via a Posterior‐Only Approach

“…In the present cases, the S 3 nerve roots and above were preserved and no patients had experienced local recurrence during the follow up. The neurologic outcome of the present study is in accordance with the results reported in the literature [14][15][16]18,19 . Larger studies are encouraged to ascertain the efficacy of variable management approaches.…”

Can the ACS‐NSQIP surgical risk calculator predict postoperative complications in patients undergoing sacral tumor resection for chordoma?

“…[27][28][29] The use of the calculator in sarcoma patients, however, has been limited; with a study by Slump et al 23 showing it was a poor predictor of complications following flap reconstruction for extremity sarcoma. One likely reason for this is that tumor-related factors such as the size and the location (high vs low sacrectomy), which have been shown to influence the outcome in chordoma, 2,15,30 are not accounted for based on the CPT codes available and not captured by the calculator.…”

Assessment of patient experiences following total sacrectomy for primary malignant sacral tumors: A qualitative study

“…All patients had bowel and bladder dysfunction postoperatively . van Wulfften Palthe et al reported 10 patients who received en bloc sacrectomy with the L5 nerve root spared. They investigated the postoperative outcomes using the National Institutes of Health Patient Reported Measurement Information System and concluded that a preoperative discussion should occur with these patients about the potential effects on physical and mental functions .…”

“…van Wulfften Palthe et al reported 10 patients who received en bloc sacrectomy with the L5 nerve root spared. They investigated the postoperative outcomes using the National Institutes of Health Patient Reported Measurement Information System and concluded that a preoperative discussion should occur with these patients about the potential effects on physical and mental functions . After a thorough literature review, we believe the sample size of the current study is the largest to date, which might allow us to evaluate the oncological prognosis of total en bloc sacrectomy and the effect of this procedure on patient experiences.…”