Surgical strategy for the management of sacral giant cell tumors: a 32-case series

Li, Guodong; Fu, Dong; Chen, Kai; Ma, Xiao‐Jun; Sun, Mengxiong; Sun, Wei; Li, Jian; Cai, Zhendong

doi:10.1016/j.spinee.2012.06.014

Cited by 23 publications

(29 citation statements)

References 15 publications

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“…Our recurrence rate (30%) is similar to that reported in other studies that included patients treated with wide resection (20.3%–38.9%). 13,20,21,26,35 The absence of local recurrence in patients who received both radiotherapy and embolization is noteworthy.…”

Section: Discussionmentioning

confidence: 98%

Conservative surgery in the treatment of giant cell tumor of the sacrum: 35 years’ experience

Domovitov

Chandhanayingyong

Boland

et al. 2016

SPI

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OBJECT There is no consensus regarding the appropriate treatment of sacral giant cell tumor (GCT). There are 3 main management problems: tumor control, neurological loss, and pelvic instability. The objective of this study was to examine oncological, neurological, and structural outcomes of sacral GCT after intralesional excision and local intraoperative adjunctive treatment. METHODS The authors retrospectively reviewed the records of 24 patients with sacral GCT who underwent conservative surgery (intralesional resection/curettage) at Memorial Sloan Kettering Cancer Center from 1973 through 2012. They analyzed patient demographic data, tumor characteristics, and operative techniques, and examined possible correlations with postoperative functional outcomes, complications, recurrence, and mortality. RESULTS There were 7 local recurrences (30%) and 3 distant recurrences (13%). Three of 24 patients (12.5%) had significant neurological loss after treatment—specifically, severe bowel and/or bladder dysfunction, but all regained function within 1–4 years. Larger tumor size (> 320 cm3) was associated with greater postoperative neurological loss. Radiation therapy and preoperative embolization were associated with prolonged disease-free survival. There were no local recurrences among the 11 patients who were treated with both modalities. Based on radiographic and clinical assessment, spinopelvic stability was present in 23 of 24 patients at final follow-up. CONCLUSIONS High local and distant recurrence rates associated with sacral GCT suggest the need for careful local and systemic follow-up in managing these patients. Intraoperative preservation of sacral roots was associated with better pain relief, improvement in ambulatory function, and retention of bowel/bladder function in most patients. Fusion and instrumentation of the sacroiliac joint successfully achieved spinopelvic stability in cases deemed clinically unstable. Despite improvement in the management of sacral GCT over 35 years, a need for novel therapies remains. The strategy of combining radiotherapy and embolization merits further study.

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Section: Discussionmentioning

confidence: 98%

Conservative surgery in the treatment of giant cell tumor of the sacrum: 35 years’ experience

Domovitov

Chandhanayingyong

Boland

et al. 2016

SPI

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“…When only the S 1 nerve root is preserved, anal sphincter function is lost postoperatively; when the S 2 nerve roots are preserved bilaterally, bladder and bowel function can be preserved in 50% of patients; and when an S 3 nerve root is preserved unilaterally, most patients retain anal sphincter function [12][13][14] . In this study, two patients underwent resection of the S 1 nerve roots bilaterally and had motion dysfunction of the lower limbs and anal sphincter dysfunction postoperatively; prior to surgery one of these patients had nerve pain in the lower limbs and one difficulty with defecation.…”

Section: Relationship Between Sacral Nerve Preservation and Nerve Funmentioning

confidence: 99%

Surgical Treatment of Sacral Neurogenic Tumor: A 10‐year Experience with 64 Cases

Sun

Zhang

et al. 2016

Orthopaedic Surgery

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“…The choices of operative treatment are en bloc vertebrectomy (EV) or intralesional resection (IR). 5 , 6 Because of the proximity of vital structures to the vertebrae, EV may be too damaging to undertake in some cases. Therefore, IR might be the alternative choice in selected cases.…”

Section: Introductionmentioning

confidence: 99%

Systematic Review and Meta-analysis of En Bloc Vertebrectomy Compared with Intralesional Resection for Giant Cell Tumors of the Mobile Spine

Luksanapruksa

Buchowski

Singhatanadgige

et al. 2016

Global Spine Journal

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Study Design Systematic review and meta-analysis. Objective To compare the recurrence and perioperative complication rate of en bloc vertebrectomy (EV) and intralesional resection (IR) in the giant cell tumor of the mobile spine (SGCT). Methods We systematically searched publications in the PubMed and Embase databases for reports of SGCTs, excluding the sacrum. Two reviewers independently assessed all publications. A meta-analysis was performed using local recurrence and postoperative complications as the primary outcomes of interest. Results There were four articles reporting recurrence and two articles reporting postoperative complications. All included articles were case series. In all, 91 patients were included; 49 were treated with IR and 42 were treated with EV. Local recurrence rates were 36.7 and 9.5% in the IR and EV groups, respectively. Rates of postoperative complications were 36.4% with IR and 11.1% with EV. Overall, patients treated with EV not only had a lower recurrence rate (relative risk [RR] 0.22; 95% confidence interval [CI] 0.09 to 0.52) but also had a lower postoperative complication rate (RR 0.34; 95% CI 0.07 to 1.52) compared with IR. Conclusions Based on the limited data obtained from systematic review, SGCT patients treated with EV had a lower recurrence rate and fewer postoperative complications than those treated with IR.

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Surgical strategy for the management of sacral giant cell tumors: a 32-case series

Cited by 23 publications

References 15 publications

Conservative surgery in the treatment of giant cell tumor of the sacrum: 35 years’ experience

Conservative surgery in the treatment of giant cell tumor of the sacrum: 35 years’ experience

Surgical Treatment of Sacral Neurogenic Tumor: A 10‐year Experience with 64 Cases

Systematic Review and Meta-analysis of En Bloc Vertebrectomy Compared with Intralesional Resection for Giant Cell Tumors of the Mobile Spine

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