Role of adjuvant cryosurgery in intralesional treatment of sacral tumors
Results of a 3-11-year follow-up
Yehuda Kollender, M.D. 1, Issac Meller, M.D. 1, Jacob Bickels, M.D. 1, Gideon Flusser, M.D. 2, Josefin Issakov, M.D. 3, Ofer Merimsky, M.D. 4, Nissim Marouani, M.D. 5, Alexander Nirkin, M.D. 1, Avi A. Weinbroum, M.D. 5 *
1National Orthopedic Oncology Unit, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
2Department of Radiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
3Department of Pathology, Tel-Aviv Sourasky Medical Center, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
4Bone and Soft Tissue Oncology Unit, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
5Post-Anesthesia Care and Acute Pain Control Unit, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
email: Avi A. Weinbroum (email@example.com)
*Correspondence to Avi A. Weinbroum, Post-Anesthesia Care Unit, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel
The authors declare that they have neither obligation to the manufacturers of the CRYO-HIT system, nor have they any financial interest, consultative agreement, stock or other interest in the company.
Fax: (011) 972-3-6925749
Cryosurgery is an adjuvant surgical technique for the treatment of benign aggressive, low-grade malignant and metastatic tumors of long bones. It has been used rarely to treat sacral tumors, mainly because of potential damage to nerves, blood vessels, and intrapelvic organs.
The authors described their experience with this procedure and provided medium and long-term follow-up results.
Fifteen procedures of cryosurgery of the sacrum were performed in 14 patients to improve the therapeutic outcome of a variety of tumors. The patient group included 7 males and 7 females with a mean age of 42 ± 24 years. Three patients were younger than 20 years of age.
The procedures were performed at the Tel Aviv Sourasky Medical Center between January 1991 and January 1999.
There were seven benign aggressive lesions (four giant cell tumors and three aneurysmal bone cysts), one benign schwannoma, one low-grade chondrosarcoma, five metastatic carcinomas, and one high-grade Ewing sarcoma, all localized at level S2 or higher. Eight of the bone tumors also involved significant anterior or posterior soft tissue. All patients had severe preoperative pain radiating to the buttocks, perineum, and lower limbs and 9 (64%) patients had bladder and/or rectal dysfunction.
Invasive diagnostic procedures and radiation (if warranted) preceded surgery. Sacral posterior fenestration and burr drilling were followed by two-cycle cryosurgery using the open pour technique or the argon-helium-based heat-freeze system.
All interventions were performed under combined general and regional anesthesia and concluded uneventfully with moderate blood loss. Thirteen patients were discharged home after 8 ± 5 days (one patient remained hospitalized for 30 days).
Only two patients experienced local disease recurrence during a 3-11-year follow-up period: one was retreated successfully by cryosurgery and the other underwent sacrectomy and radiotherapy elsewhere, with a subsequent loss of visceral functions.
No patient suffered chronic pain, deep wound infections, or significant neurologic deficits and all were satisfied with the esthetic outcome.
Cryosurgery is a conservative, feasible, and safe adjuvant technique in the treatment of sacral tumors. It is associated with minimal permanent neurologic and vascular injury compared with sacrectomy.
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