Sacrectomy is intended to resect aggressive local and life-threatening disease. Reconstruction can be difficult. This article reports on the use of sacrectomy for tumor and tumor-like conditions. Procedures included 9 partial, 7 subtotal, 7 hemi-, and 4 total sacrectomies. Of 22 patients with primary malignant disease, 64% were alive without evidence of disease. The local recurrence rate was 27%. Thirty-two percent developed metastatic disease and 32% died from progressive disease. The complication rate was 33%. Tumor control was achieved in 73%. Postoperative complications occurred in 33%. Sacral resection remains a challenging operation.