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What Is Sacrectomy?

Sacrectomy is major surgery that removes part or all of the sacrum, the triangular bone at the base of the spine between the pelvic bones. The operation is most commonly performed for primary sacral tumors such as chordoma or sarcoma and for selected locally aggressive or recurrent cancers involving the sacrum. A partial sacrectomy removes only the involved portion, while a total sacrectomy removes essentially the entire sacrum. The extent of bone and nerve removal is planned to achieve tumor control while preserving neurologic and pelvic function whenever oncologically possible.

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What Is Sacrectomy?

Sacrectomy is major surgery that removes part or all of the sacrum, the triangular bone at the base of the spine between the pelvic bones. The operation is most commonly performed for primary sacral tumors such as chordoma or sarcoma and for selected locally aggressive or recurrent cancers involving the sacrum. A partial sacrectomy removes only the involved portion, while a total sacrectomy removes essentially the entire sacrum. The extent of bone and nerve removal is planned to achieve tumor control while preserving neurologic and pelvic function whenever oncologically possible.

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Why Is Sacrectomy Performed?

The procedure is used when a sacral tumor requires wide or en bloc resection to obtain an adequate surgical margin. Chordoma is a classic indication because complete tumor removal with negative margins provides the best chance of durable local control. Sacrectomy can also be required for selected sarcomas, recurrent rectal cancer, or other tumors that directly invade the sacrum. Surgical planning considers tumor level, pelvic-organ involvement, major vessels, sacral nerve roots, spinal stability, metastatic disease, and whether reconstruction will be required.

How Is Sacrectomy Performed?

The surgical approach depends on how high the tumor extends and can be posterior only or combined anterior and posterior. The surgeon divides the sacrum above and around the tumor and removes the involved bone and soft tissue as a single specimen when an en bloc resection is planned. Sacral nerve roots are preserved when safe, but roots directly involved by tumor can require sacrifice to obtain an oncologically adequate margin. High partial or total sacrectomy can require reconstruction of the spine and pelvis with rods, screws, grafts, or other implants.

What Is Recovery Like After Sacrectomy?

Recovery is prolonged because sacrectomy can involve major pelvic surgery, large wounds, nerve-root sacrifice, and complex reconstruction. Patients require close management of pain, wound healing, bowel and bladder function, mobility, blood loss, and prevention of infection and blood clots. Rehabilitation focuses on standing, walking, transfers, pelvic stability, and adaptation to any permanent neurologic deficits. Functional outcome depends strongly on how much sacrum is removed and which sacral nerve roots can be preserved.

What Are the Risks and Complications?

Possible complications include major bleeding, wound infection, wound breakdown, cerebrospinal fluid leak, bowel or urinary injury, blood clots, and failure of spinal or pelvic reconstruction. Sacral nerve-root removal can cause permanent bowel, bladder, sexual, sensory, or lower-extremity motor dysfunction. High-level and total sacrectomies generally carry greater functional loss than lower partial resections. Tumor recurrence can still occur despite aggressive resection, especially when a negative surgical margin cannot be achieved.

Frequently Asked Questions About Sacrectomy

What tumors are commonly treated with sacrectomy?

Primary sacral chordoma and sarcoma are common oncologic indications, although selected recurrent pelvic cancers can also require sacral resection.

Is the entire sacrum always removed?

No. Partial sacrectomy removes only the involved portion of the sacrum, while total sacrectomy is reserved for tumors that require more extensive removal.

How do sacral nerve roots affect function after sacrectomy?

Preserving lower sacral roots, especially S3 and below, greatly improves the chance of retaining bowel and bladder function compared with higher bilateral nerve-root sacrifice.

Can the pelvis require reconstruction after sacrectomy?

Yes. High partial or total sacrectomy can disrupt spinopelvic stability and require reconstruction with rods, screws, grafts, or other implants.

References

Irreversible Electroporation: Background, Theory, and Review of Recent Developments in Clinical Oncology. PubMed. https://pubmed.ncbi.nlm.nih.gov/34471825/. Date Accessed September 11, 2026.

Anaesthetic management during open and percutaneous irreversible electroporation. PubMed. https://pubmed.ncbi.nlm.nih.gov/25173767/. Date Accessed September 11, 2026.

Irreversible electroporation for nonthermal tumor ablation in the clinical setting: a systematic review of safety and efficacy. PubMed. https://pubmed.ncbi.nlm.nih.gov/24656178/. Date Accessed September 11, 2026.

Efficacy and safety of irreversible electroporation for malignant liver tumors: a systematic review and meta-analysis. PubMed. https://pubmed.ncbi.nlm.nih.gov/33638687/. Date Accessed September 11, 2026.

Irreversible electroporation as a focal therapy for localized prostate cancer: A systematic review. PubMed. https://pubmed.ncbi.nlm.nih.gov/38314081/. Date Accessed September 11, 2026.