Complications, secondary interventions and long term morbidity after en bloc sacrectomy

Purpose: En bloc sacrectomy is a demanding surgical procedure to remove tumors from the sacrum. Comprehensive data on readmissions for complications endured months to years after initial discharge are scant. The purpose of this study is to present the long-term complications, readmissions and secondary interventions for patients having undergone en bloc sacrectomy. Methods: Patients were included if en bloc sacrectomy and follow-up were conducted in the authors institution. Correspondence from all specialties involved in the treatment of patients was retrieved. Predefined parameters were scored and assigned to five distinct phases: diagnostic phase; surgery; postoperative period to 1 year after surgery; second year after surgery until follow-up and last follow-up. Results: Sixteen patients underwent anterior–posterior en bloc sacrectomy for a locally aggressive tumor (n = 2); malignant tumor (n = 13) or solitary metastasis (n = 1). The type of resection was low (n = 1); middle (n = 3); high (n = 4); total (n = 3) and hemisacrectomy (n = 5). The median surgical duration was 12.7 h and median blood lost was 12 l. A total of 73 major complications (average per patient 5; median 4; range 0–12) were recorded and 73 secondary interventions (average per patient 5; median 5; range 0–11) were performed in the first year postsurgery. From the second year until follow-up complications and secondary interventions markedly decreased. At final follow-up (65–266 months), considerable morbidity was found for the eleven patients still alive. Conclusions: En bloc sacrectomy is a procedure with a high rate of major complications, regardless of tumor histology, often necessitating readmissions and secondary interventions. Long-term survival is associated with considerable morbidity and extensive preoperative counseling should be conducted to discuss the risks and outcome of the procedure.