Fifty consecutive patients with sacrococcygeal chordomas treated during 1941-1991 at the Tata Memorial Hospital in India were studied retrospectively. Pain was the commonest presenting symptom (82%). An average time lapse of 14 months between the onset of pain and definitive diagnosis emphasizes the importance of a high index of suspicion and prompt use of sophisticated imaging techniques leading to an early diagnosis. All patients underwent a partial sacrococcygectomy, through a sacral approach in 22 patients (44%) and an abdominosacral approach in 28 (56%). Postoperative complications included urinary incontinence (14%), rectal incontinence (6%), hemorrhage (4%), and rectal injury (2%). Radiotherapy offered significant pain relief to patients with widespread recurrence. A total of 38 patients were ambulatory, and 12 needed support. The average disease-free survival was 63 months, and the overall survival was 7 years. Aggressive resection through a combined abdominosacral approach offers the best results. Because postrecurrence salvage rates are poor, the primary surgery must be complete and curative.