Long-Term Bladder, Bowel, and Ambulatory Function After Sacrectomy Surgery.

Study design: Retrospective cohort study.

Objective: To assess 5-year bladder, bowel, and ambulatory function in patients receiving sacral tumor resection surgery.

Summary of background data: Sacral tumors are rare and slow growing, often leading to late diagnoses and large tumor size. Surgical resection is the standard of care, and frequently involves nerve root sacrifice. These structures are important for bladder, bowel, and ambulatory function, and previous studies have limited follow-up. Hence, little is known regarding how sacral nerve function changes over time after sacrectomy surgery.

Methods: We conducted a retrospective analysis of 43 patients who received surgery at our institution. Patients were stratified into groups based on osteotomy level (intralesional, low, mid, and high). Descriptive statistics were calculated with point estimates. Kruskal-Wallis tests were used to compare oncologic, surgical, and functional outcomes across sacrectomy groups. Cumulative link mixed models (CLMMs) were used to assess functional trends over time.

Results: There were significant differences in preoperative and 1-year bladder, bowel, and ambulatory function (P<0.05). However, there were no significant differences between 1-year and 5-year bladder, bowel, and ambulatory function (P=0.99, P=0.80, and P=0.72). At 5-years, bladder function was significantly better in the intralesional and low sacrectomy versus the mid sacrectomy group (P=0.04 and P=0.002). At 5-years, bowel function was significantly better in the intralesional and low sacrectomy versus the mid sacrectomy group (P=0.01 and P=0.01). At 5-years, ambulatory function was significantly better in the low sacrectomy versus the high sacrectomy group (P=0.006).

Conclusion: As expected, higher osteotomy level was associated with poorer function. Bladder, bowel, and ambulatory function was shown to stabilize at 1-year postoperatively. This can serve as an assessment point for long-term function and can help set patient expectations after surgery.

Level of evidence: Level III, cohort study.