Bowel and Bladder Dysfunction and Patient-Reported Outcomes in Patients Undergoing a Sacrectomy for a Primary Bone Tumor an Observational Study From the Primary Tumor Research and Outcomes Network (PTRON)
Taryn E. Ludwig, Laurence D. Rhines, Jeremy Reynolds, Ziya L. Gokaslan, Aron Lazary, Nicolas Dea, Charles G. Fisher, Alessandro Luzzati, Alessandro Gasbarrini, Y. Raja Rampersaud, Michelle J. Clarke, Alexander C. Disch, Riccardo Cecchinato, Stefano Boriani, Praveen V. Mummaneni, Daniel G. Tobert, Ori Barzilai, C. Rory Goodwin, Cordula Netzer, Ilya Laufer, Jorrit-Jan Verlaan, Raphaële Charest-MorinStudy Design
Prospective cohort.
Objective
The primary objective was to describe bowel and bladder (BB) function by nerve root sacrifice following a Sacrectomy. Secondary objectives were to compare patient reported outcomes (PROs) based on BB function at 12 months, and to assess surgeon–patient reported BB function concordance.
Methods
Data from AO Spine Knowledge Forum Tumor Primary Tumor Research and Outcomes Network (PTRON) registry included patients who underwent a sacrectomy (S1–S5) for a primary bone tumor, with at least one PRO reported at baseline and 12 months. BB function was recorded at baseline and 12 months. PROs included EQ-5D, SOSGOQv2.0, SF-36, leg/back NRS, ECOG.
Results
Eighty-one patients were included. Bilateral S1–S2 sacrifice was associated with complete BB dysfunction; preservation of at least one S3 root was associated with preserved BB function in more than half of cases. Distal S4–S5 resections often preserved function, but about one-third had BB dysfunction. Agreement between surgeon–patient reported BB function was moderate (κ 0.39–0.45). At 12 months, patients with preserved BB function reported higher EQ-5D (0.70 vs 0.60, p=0.025) and SOSGOQv2.0 (83.5 vs 67.5, p=0.031), better ECOG (p= 0.028) and lower leg pain (0.5 vs 4.5, p=0.013).
Conclusion
A substantial proportion of patients experience BB dysfunction after sacrectomy, particularly with more cranial resections. This dysfunction aligned with worse PROs, greater pain, and poorer performance status. Agreement between surgeon- and patient-reported BB outcomes was moderate, emphasizing the importance of incorporating patient-reported measures into follow-up and counseling.