Surgical outcomes in oncological sacrectomy: a detailed analysis of surgical site infections (SSI)

Abstract

IntroductionSacral surgeries, especially sacrectomies, are complex due to the sacrum's anatomical intricacies and its proximity to vital neurovascular structures. These procedures are primarily performed for the treatment of primary sacral malignancies, metastatic lesions, and traumatic injuries. Infection is a significant concern in sacrectomies, given the large incisions, extensive soft tissue dissection, and compromised immune systems in many patients. This retrospective study aims to evaluate the outcomes of sacrectomy surgeries, focusing on surgical approaches, reconstruction methods, and infection profiles, to better understand the challenges and outcomes associated with these procedures.MethodsThis retrospective study included 18 patients with sacral pathologies, such as chordomas, malignant mesenchymal tumors, and sacral metastases. Data was collected on demographics, tumor characteristics, surgical approaches, nerve root sacrifice, and reconstructive techniques like VRAM flaps. Postoperative outcomes, including wound complications, neurological issues, recurrence rates, and infections, were analyzed. The data was analyzed using SPSS, and Kaplan-Meier analysis was performed to estimate survival.ResultsThe study involved 18 patients (94.4% male) with a median age of 64 years. Tumor size ranged from 30 mm to 200 mm, and volume from 60 cm(3) to 6,500 cm(3). Most patients underwent partial sacrectomy (83.3%). Flap reconstruction was performed in 27.8% of cases. Wound complications occurred in 50%, and neurological complications in 55.6%. Recurrence was observed in 27.8%, and 5 patients (27.8%) died during follow-up, with an estimated 5-year survival rate of approximately 75%. Infections in VRAM flap patients were predominantly E. coli and polymicrobial anaerobes, requiring debridement with hospital stays ranging from 9 to 21 days. Non-flap patients had more resistant infections, including Pseudomonas aeruginosa, Acinetobacter baumannii requiring extended hospital stays (15-37 days) and multiple debridements. No significant difference in infection rates was found between VRAM flap and non-flap groups, though VRAM cases had larger tumors and longer surgeries.ConclusionIn conclusion, surgical site infections remain a significant challenge in sacrectomy patients. Vascularized flaps may offer protection against resistant Gram-negative strain infections, while surgical debridement is essential for managing anaerobic infections. Future research should focus on optimizing infection prevention, improving wound healing strategies, and enhancing nutritional support to improve outcomes for sacrectomy patients.