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

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Surgery with curative intent by en bloc total or partial sacrectomy is the treatment of choice for the majority of patients with primary malignant tumors of the sacrum. In selected circumstances, it may be also indicated for primary or recurrent pelvic malignancies extending to the sacrum with no evidence of metastasis, most commonly colorectal or gynecologic cancers, often in association with pelvic exenteration [2, 7]. Above all, sacrectomy with negative surgical margin represents the treatment goal for patients with chordoma, by far the most common primary malignant sacral neoplasm, because it is predictably associated with long-term survival and cure [2].
Sacrectomy is a technically demanding procedure requiring multidisciplinary competence. The complex anatomy including proximity to important blood vessels and neurological structures presents formidable surgical challenges, and the procedure also is hard on the patient, as complications occur commonly, and compromised function is the norm. The extent of neurologic loss following sacrectomy can include bowel, bladder, sexual, and even lower-extremity function, depending upon the level of nerve root transection [3, 4].
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