EP575 - Sacrococcygeal Chordomas: A 25-Year Experience from the Mayo Clinic

ePoster Presenter(s)

• 

  Richa Bisht, MD (she/her/hers)

  General Surgery Resident
  Mayo Clinic
  Mayo Clinic, Rochester
  Rochester, MN, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• DC

  Dovile Cerkauskaite, MD

  Research Fellow
  Mayo Clinic
  Rochester, Minnesota, United States

  Disclosure information not submitted.
• 

  Amit Merchea, MD (he/him/his)

  Associate Professor of Surgery
  Mayo Clinic Florida
  Jacksonville, FL, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• NM

  Nitin Mishra, MBBS, MS, MPH

  Consultant
  Mayo Clinic Arizona
  Phoenix, Arizona, United States

  Disclosure information not submitted.
• 

  David w. Larson, MD MBA

  consultant
  Mayo Clinic
  Mayo Clinic
  rochester, MN, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Eric Joseph Dozois, Professor of Surgery

  Chair, Colon and Rectal Surgery
  Mayo Clinic
  Rochester, Minnesota, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.

Senior Author(s)

• 

  William R. Perry, MBChB MPH FRACS FACS FASCRS (he/him/his)

  Associate Professor of Surgery
  Mayo Clinic
  Mayo Clinic
  Rochester, Minnesota, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Purpose/Background: Sacrococcygeal chordomas are rare, slow-growing, and locally aggressive malignant tumors arising from embryonic notochordal remnants. Their management remains challenging because of proximity to critical neurovascular and visceral structures, the technical difficulty of achieving negative margins, and the high risk of local recurrence despite complete (R0) resection. This study aimed to describe the clinicopathologic features, surgical management, and long-term oncologic outcomes of patients with sacroccogyeal chordomas treated across all three Mayo Clinic campuses over 25 years.

Methods/Interventions: A retrospective review was conducted of all patients with histologically proven sacrococcygeal chordoma who underwent surgical resection between 2000 and 2025 at Mayo Clinic campuses (Rochester, Arizona, and Florida). Demographic, clinical, radiologic, operative, and histopathologic data were collected. Primary outcomes were local recurrence and overall Survival (OS). Secondary outcomes included disease-free Survival (DFS), margin status, and perioperative morbidity (Clavien-Dindo grade ≥ III). DFS and OS were estimated using the Kaplan-Meier analysis.

Results/Outcomes: Sixty-six patients were analyzed (59.1% males, mean age of 55±13 years). Most (77.3%) were symptomatic, commonly with lower back pain (53.0%), pelvic pain or pressure (30.3%), urinary symptoms (15.2%), neurological symptoms (13.8%), or constipation (13.6%). The median tumor size on preoperative MRI/CT was 6.5 cm (IQR: 2.1-24.9 cm), most frequently located in the midline (71.2%) and below the S3 level (50.0%). Surgical approaches included posterior in 51.5%, combined anterior-posterior in 36.4%, and anterior in 10.6%. Negative margins (R0) were achieved in 95.5% of resections. Major complications (Clavien-Dindo grade ≥ III) occurred in 31.5%, predominantly wound-related; 30-day mortality was 0%. At a median follow-up of 82.5 months (IQR: 40.0-173.5 months), local recurrence occurred in 14 (21.2%) patients, with a median time to recurrence of 28.0 months (IQR: 9.0-74.0 months). The 5-year disease-free survival rate was 71.0% (95% CI 60.3-83.8%). The 5-year overall Survival was 90.6% (95% CI: 83.1-98.9%). No clinicopathologic factors were significantly associated with recurrence or Survival on univariate analysis.

Conclusion/Discussion: En bloc resection with negative margins provides durable disease control in sacrococcygeal chordoma, achieving 5-year DFS and OS rates of 71% and 91%, respectively. Despite a 31% rate of major complications, perioperative mortality was 0%, underscoring that meticulous multidisciplinary management can yield excellent long-term outcomes in this complex disease.

Figure 1. Overall Survival after sacrococcygeal chordoma resection.
Figure 2. Disease-Free Survival after sacrococcygeal chordoma resection.