Аннотация:Introduction: Malignant tumors of the sacrum are quite
rare. There are many cases where the tumor involving the
sacrum and the rectum can cause serious problems in the
choice of surgical technique. The aim of study to analyze
results of surgical treatment of patients with tumors of the
sacrum and the rectum. Defined indications and estimate
results of treatment group of patients.
Materials and Methods: Between 2002 and 2013 years
67 patients with primary and metastatic sacral tumors
were operated. In 12 cases we observed tumors involving
the sacrum and the rectum. Histology rate was presented
with chordoma in 5 cases and rectal cancer in 7. All
patients with chordoma had previous non radical surgical
treatment in other clinics. The patients age range from 47
to 70 years. In study group all patients were operated with
combined approach. First step includes resection of
sigmoid colon, mobilization of intrapelvic component,
sigmoidostomy and transposition of recto-abdominal flap.
Second step operation performed in prone position and
includes nerve root mobilization, posterior sacral and
rectum en-block resection with soft tissue plastic by RAF.
The indication for describe surgical method was detected
by CT, MRI examination and colonoscopy.
Results: Five operations were performed. The mean
surgical time was 7 hours, blood loss was 3300ml. In
postoperative period we not observed deep wound
complications. All neurological complications were
associated with nerve root resection. All patients followed
up from 6 to 67 months. Eight patient alive and five
without evidence of disease. One patient with previous
non radical surgical treatment of sacral chordoma has
multiple local recurrence 14 months after surgery. One
patient died from cardiovascular disorder after 16 months.
Three patients died from progression of disease. Patients
with rectal cancer receive additional treatment. All patients
in early postoperative period were ambulatory and had
good function.
Conclusions: This method provides good results for
difficult patient with tumor involves sacrum and rectum.
Technical problems of surgical treatment can be decided
only by multidisciplinary strategy