Malignant sacral tumors present unique problems because of their location deep in the pelvis, their juxtaposition to the ureters, rectum, and iliac vessels, and the need to preserve spinal stability and sacral nerve function after resection. The simultaneous abdominosacral resection circumvents many of these problems since it provides good exposure of the intraabdominal structures, allows precise selection of the level of sacral resection, and avoids damage to the sacral nerve roots. Tolerable control of bladder and bowel functions is possible by preservation of the S1 nerve roots, and spinal stability can be maintained with preservation of the body of the S1 vertebra. Because malignant tumors of the sacrum have a high propensity for local recurrence, we believe that the exposure afforded by the sacroabdominal approach provides an opportunity to obtain a wide margin of resection during initial resection of these tumors.
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