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Failure to achieve adequate margins has been shown to result in a higher rate of recurrence. Frequent involvement of major pelvic structures further complicates their surgical management, and multidisciplinary teams are best suited to perform these resections. Here, we present a patient with a large, locally invasive sacral chordoma and review recent literature surrounding the current management of such chordomas. A 52-year-old male was found to have an infiltrating mass after magnetic resonance imaging (MRI) of the prostate for rising prostate-specific antigen (PSA). Computerized tomography (CT)-guided biopsy confirmed diagnosis of sacral chordoma, and the patient underwent excision with a two-stage operation utilizing a combined anterior-posterior approach. After a 49-day hospitalization complicated by small bowel obstruction (SBO), he was discharged to inpatient rehab (IPR), with subsequent receipt of adjuvant radiation therapy and no recurrence at 1\u00a0year of follow-up. A narrative review of pertinent literature over the last 20\u00a0years (2005-2025) was completed. Our search strategy identified 68 articles, allowing in-depth discussion of topics including tumor workup, surgical approach, emerging operative technologies, prognostic factors contributing to recurrence and survival rates, and the benefit of excision at high-volume centers.<\/jats:p>","DOI":"10.1177\/00031348251371206","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:15:41Z","timestamp":1756253741000},"page":"560-567","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Two-Stage Excision of Advanced, Infiltrative Sacral Chordoma"],"prefix":"10.1177","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9984-9746","authenticated-orcid":false,"given":"Nathan","family":"Walter","sequence":"first","affiliation":[{"name":"University of Tennessee College of Medicine Chattanooga"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taylor 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