Decancellation Sacral Osteotomy in Iliosacral Tumor Resection: A Technique for Precise Sacral Margins

Farid, Yasser R.

doi:10.1007/s11999-009-1031-3

Cited by 4 publications

(2 citation statements)

References 23 publications

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“…However, en-bloc resection of iliosacral tumors poses significant challenges due to complex local anatomy, difficulty in nerve root preservations, control of intraoperative bleeding and functional reconstructio n [6,7]. Resections of pelvic tumors with overly generous margins are generally avoided in limb salvage due to potential anatomic and functional disruptions, thus risking inadequate resection margins and local recurrenc e [1,2,8]. Inadequate margin is more often at sacral side due to sacral anatomy and surgical exposur e [9].…”

Section: Introductionmentioning

confidence: 99%

Iliosacral Bone Tumor Resection Using Cannulated Screw-Guided Gigli Saw - A Novel Technique

Chin

Tang

et al. 2021

World J Surg Onc

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Background Adequate margins are technically difficult to achieve for malignant tumors involving the sacroiliac joint due to limited accessibility and viewing window. In order to address the technical difficulties faced in iliosacral tumor resection, we proposed a technique for precise osteotomy, which involved the use of canulated screws and Gigli saw (CSGS) that facilitated directional control, anteroposterior linkage of resection points and adequate surgical margins. The purpose of the current study was to evaluate whether CSGS technique facilitated sagittal osteotomy at sacral side, and were adequate surgical margins achieved? Also functional and oncological outcomes was determined along with the noteworthy complications. Methods From April 2018 to November 2019, we retrospectively reviewed 15 patients who underwent resections for primary tumors of pelvis or sacrum necessitating iliosacral joint removal using the proposed CSGS technique. Chondrosarcoma was the most common diagnosis. The osteotomy site within sacrum was at ipsilateral ventral sacral foramina in 8 cases, midline of sacrum in 5 cases, and contralateral ventral sacral foramina and sacral ala with 1 case each. The average intraoperative blood loss was 3640 mL (range, 1200 and 6000 mL) with a mean operation duration of 7.4 hours (range, 5 to 12 hours). The mean follow-up was 23.0 months (range, 18 and 39 months) for alive patients. Results Surgical margins were wide in 12 patients (80%), wide-contaminated in 1 patient (6.7%), and marginal in 2 patients (13.3%). R0 resection was achieved in 12 (80%) patients and R1 resection in 3 patients. There were three local recurrences (20%) occurred at a mean time of 11 months postoperatively. No local recurrence was observed at sacral osteotomy. The overall one-year and three-year survival rate was 86.7% and 72.7% respectively.Complications occurred in three patients. Conclusions The current study demonstrated that CSGS technique for tumor resection within the sacrum and pelvis was feasible and can achieve ideal resection accuracies. The use of CSGS was associated with high likelihood of negative margin resections in the current series. Intraoperative use of CSGS appeared to be technically straightforward and allowed achievement of planned surgical margins. It is worthwhile to consider the use of CSGS technique in resection of pelvic tumors with sacral invasion and iliosacral tumors, however further follow-up at mid to long-term is warranted to observe local recurrence rate.

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Section: Introductionmentioning

confidence: 99%

Iliosacral Bone Tumor Resection Using Cannulated Screw-Guided Gigli Saw - A Novel Technique

Chin

Tang

et al. 2021

World J Surg Onc

View full text Add to dashboard Cite

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“…[1][2][3] For iliosacral sarcoma resection, there are substantial risks, including inadequate margins, local recurrence, nerve root loss, and an unsatisfactory functional outcome. 1,3 Adequate margins are difficult to achieve when performing an internal hemipelvectomy for bone sarcomas involving the sacroiliac joint. 4 Advances in chemotherapy and radiographic imaging have allowed type I/IV resections to be performed on selected cases.…”

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confidence: 99%