Objective      To summarize the technique and surgical outcome for total resection of lower sacral tumor.       Methods      This retrospective study included 7 cases with total resection of lower sacral tumor (involving S

3

and below) from January 2010 to February 2013. We used extraperitoneal approach to ligature the bilateral internal iliac artery in 7 patients

separated the tumor

and used transverse incision to separate the sacrum from surrounding ligaments and muscles. We then separated the sacrum to S

2

-S

3

junction and ligatured the dural sac

cut off the sacrum at the S

2

-S

3

junction

and remove the tumor out of the envelope.       Results      All patients underwent the operation successfully with no perioperative death or serious complication. The blood loss ranged from 300-650 mL (460 mL in average). One case of transient enteroplegia and one case of transient gatism were reported. The postoperative pathological results revealed that there were 4 chordomas

2 giant cell tumors and 1 metastatic tumor. All patients were followed up for 4-36 months (13.6 in average). At the final follow-up there was no recurrence reported.       Conclusion      The surgery with combined anterior-posterior approach helps remove the lower sacral tumor totally

with uncomplicated surgical technique and obviously reduced recurrence rate.