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Sacrectomy: what it means to remove part of the sacrum | CION Cancer Clinics
A sacrectomy is an operation to remove part or all of the sacrum, the triangle of bone at the base of your spine, to take out a tumour in one piece. How high the cut goes decides which nerves to the bladder, bowel and legs can be kept. This page explains the different operations, the pathway, and who it is not right for. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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The short answer
What is a sacrectomy?
A sacrectomy is an operation to remove part or all of the sacrum, the flat triangle of bone at the base of your spine that sits between the two hip bones. It is done to take out a tumour growing in or into that bone, in one piece, with a rim of healthy tissue around it.
Why the sacrum is hard to operate on
The sacrum is not just a bone. The nerves that control your bladder, your bowel, your sexual function and parts of your legs pass through it. The rectum lies just in front of it. Large blood vessels run close by. So removing the bone safely means working around all of these at once, and sometimes deciding that some of them have to go with the tumour.
Why the tumour is taken out whole
Most tumours that need this operation grow slowly but come back if even a small piece is left behind. Cutting through the tumour to take it out in bits spreads cells into the wound. That is why surgeons plan to remove it in one block, even when that means a bigger operation.
What this page cannot tell you
It cannot tell you whether you need this operation, or how much bone and nerve your surgeon will need to remove. Those depend on your scans, your biopsy and where the tumour sits.
This is a rare operation. Ask how often your centre does it before you agree to a date.Different operations
How much of the sacrum is removed?
The height of the cut decides almost everything that follows, from how long you stay in hospital to what your bladder can do afterwards.
Low sacrectomy
Only the lowest part of the sacrum is removed. The joint between the spine and the pelvis stays, so no metal rods are usually needed to hold things together.
Usually means
- A shorter operation
- More of the bladder and bowel nerves kept
Middle or high sacrectomy
The cut is higher, closer to where the spine joins the pelvis. More nerves sit in the path of the tumour, and some may have to be removed with it.
Bladder and bowel changes are more likely at this level.Total sacrectomy
The whole sacrum is removed. The spine is then no longer connected to the pelvis, so the surgeons rebuild that link with rods, screws and bone graft in the same operation.
From the back, or from both sides
Low tumours can often be reached from the back alone. Higher or larger ones may need a first stage through the tummy to free the rectum and blood vessels, then a second stage from the back.
Not sure whether this applies to you?
Ask an oncologistThe pathway
What happens from the scan to going home?
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MRI and CT scans
An MRI shows the tumour, the nerves and the soft tissue around them. A CT shows the bone in detail and checks the chest for spread.
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A planned biopsy
A needle sample confirms what the tumour is. It should be planned by the team who will operate, because the needle track may have to be removed later along with the tumour.
-
Tumour board and consent
Surgeons, radiation and medical oncologists look at the scans together. You are told which nerves are likely to be kept or lost before you sign anything.
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The operation
A long operation, often with spine, bowel and plastic surgeons in the same theatre. You wake up in intensive care or a high-dependency bed.
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Rehabilitation
Physiotherapy starts early. Learning to sit, stand and manage the bladder and bowel takes weeks to months, and continues after you are home.
On your report
What do the words on the scan and biopsy report mean?
- Chordoma
- A rare, slow-growing bone tumour that often starts in the sacrum. It is the most common reason for this operation.
- En bloc resection
- Removing the tumour in one piece without cutting into it.
- Margin
- The rim of healthy tissue around what was removed. A clear margin means no tumour cells were seen at the edge.
- Sacral nerve roots
- The nerves leaving the sacrum, labelled S1 downwards. Your report may say which ones the tumour touches.
- Sacroiliac joint
- The joint where the sacrum meets each hip bone. If it is removed, the spine has to be fixed back to the pelvis.
- Spinopelvic fixation
- The rods and screws that rebuild the link between the spine and the pelvis.
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Weighing it up
Who is this operation not right for?
A sacrectomy is not offered to everyone with a tumour in the sacrum. Your treating team decides with you, and the answer is sometimes no.
When the cancer has spread widely
If the tumour in the sacrum is one of many spread through the body, an operation this large rarely helps. Radiotherapy, medicines or pain control usually do more, with far less strain on you.
When the body cannot take the strain
The operation is long and recovery is slow. Serious heart or lung disease, very poor nutrition or frailty can make the risk higher than the likely benefit. Sometimes a few weeks of building strength first changes that picture.
When the trade is not one you accept
Some people, once they understand which nerves would be lost, choose high-dose radiotherapy or a smaller aim instead. That is a real choice, and a good team will lay out what each path gives and takes away.
Ask your surgeon to say, in plain words, which nerves they expect to keep and which they may lose.Commonly believed
What do families often get wrong about sacral surgery?
"It grows slowly, so we can wait and watch."
Slow growth is exactly why these tumours become large before anyone notices. The bigger it gets, the more nerves sit in its path. Waiting can turn a lower cut into a higher one.
"Any bone surgeon can take it out."
This is a team operation. It usually needs a surgical oncologist, a spine surgeon, a bowel surgeon and a plastic surgeon, with an intensive care unit and a rehabilitation team behind them.
"If they scoop out most of it, radiotherapy can
handle the rest."
Tumours like chordoma tend to come back where pieces were left. A first operation done in bits can make a later one much harder. Removing it whole is the aim from the start.
"After this, he will never walk again."
Most people keep the nerves to the main leg muscles, and many walk again, sometimes with a stick or a frame. Your surgeon can tell you what is likely in your case.
Did you know
The biopsy for a sacral tumour matters as much as the operation. A needle passed through the wrong route can spread cells into healthy tissue. If a biopsy has not yet been done, ask for it to be planned by the team who will do the surgery.
Questions we are asked
Common questions about sacrectomy
How long does a sacrectomy take?
It is one of the longer operations in cancer surgery. A low sacrectomy from the back is shorter. A high or total sacrectomy done from the front and the back can take most of a day, and is sometimes split over two days. Your surgeon can give you an estimate once the plan is fixed.
Will I be able to control my bladder and bowel?
It depends on how high the cut is and how many nerves on each side are kept. With a low cut, most control is usually kept. With a high cut, many people need a catheter and a bowel routine. Ask your surgeon which nerves are at risk before you give consent.
How long will I stay in hospital?
Longer than for most operations. The first days are usually in intensive care or a high-dependency bed. Then the stay continues until the wound is healing, pain is controlled and you can move safely. Families should plan for a stay of a couple of weeks or more.
Why can't radiotherapy be used instead?
Sometimes it is. High-dose radiotherapy is an option for some people who cannot have surgery or choose not to. For many sacral tumours, removing the tumour whole gives the most lasting control, and radiotherapy is added before or after. Your tumour board weighs both for your situation.
Will I need metal rods in my back?
Only if the cut goes high enough to disconnect the spine from the pelvis. A low sacrectomy usually does not need them. A total sacrectomy almost always does. Rods and screws are usually permanent and are not removed unless they cause a problem.
Can I sit normally afterwards?
Not at first. The wound is over the area you sit on, so you will lie on your side or front for a while. Sitting is brought back slowly, often on a special cushion. Numbness in the buttocks can last, so skin checks become part of daily life.
What problems can happen after the operation?
Wound problems are the most common, because the wound is large and sits near the back passage. Infection, fluid collections, bleeding and blood clots can also happen. Your surgeon should explain each risk for your operation and how the team watches for it.
Is it covered by Aarogyasri or insurance?
Cancer surgery is often covered under Aarogyasri, CGHS, ECHS, EHS and most cashless insurance, but complex operations may need pre-approval and the package may not include every item. Ask for a written estimate and check it against your cover before the date is fixed.
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Sources
- National Cancer Institute — Bone Cancer
- Cancer Research UK — Bone cancer
- American Cancer Society — Bone Cancer
- NHS — Bone cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Which Tumours Need Sacral SurgeryChordoma and the other tumours behind this operationNerve Sacrifice and What It Costs YouWhat each nerve controls and what losing it meansSpinopelvic Reconstruction After SacrectomyHow the spine is fixed back to the pelvisRecovery and Rehabilitation TimelineWhat the weeks and months after look likeChoosing a Surgeon and a CentreWhat to ask before a rare, complex operation
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