Common sacral malignant tumors include chordoma, chondrosarcoma, malignant fibrous histiocytic sarcoma, etc. Giant cell tumor of bone is a common aggressive tumor of the sacrum. Since the occurrence and development of sacral tumors are relatively insidious, usually the tumors are already very large when they are detected, making surgery extremely difficult, risky and with many complications, and often the functions of urination, defecation and lower limb walking have to be sacrificed to reduce tumor recurrence and save lives. Even so, there is still a very high rate of tumor recurrence after surgery for sacral tumors in clinical practice. Through decades of development, total sacral EN-BLOC tumor resection is now considered to be the most effective means of reducing postoperative tumor recurrence. A complex case of total sacral tumor is presented. A female, 60 years old, came to the clinic with lumbosacral pain for six months and poor bowel control for more than one month. The diagnosis of malignant tumor of sacrum was confirmed after examination. (Preoperative MRI showed tumor invasion of the whole sacrum) (Postoperative lumbosacral internal fixation reconstruction) (Intraoperative total sacral tumor resection appearance photo. (Complete tumor resection) (Comparison of fluoroscopic photograph of specimen with preoperative image showing complete tumor resection)