En Bloc Resection and Pelvic Ring Reconstruction for Primary Malignant Bone Tumors Involving Sacroiliac Joint

Abstract

ObjectiveTo observe the process of sacroiliac joint invasion by primary malignant tumors of sacrum and iliac bone, and to explore the methods of surgical resection and reconstruction.MethodsFrom January 2009 to November 2017, there were nine patients with primary malignant bone tumors involving sacroiliac joints, five males and four females, aged from 16 to 63 years, with an average age of 35 years. Of these there were three cases of primitive neuroectodermal tumors, three cases of chondrosarcoma, and three cases of osteosarcoma. Pelvic ring reconstruction was performed with longitudinal half sacrum, sacroiliac joint and partial iliac bone block excision and screw‐rod system combined with bone grafting.ResultsThe operation time was 155–310 min, with an average of 245 ± 55 min, and the bleeding volume was 1400–8500 ml, with an average of 3111 ± 2189 ml. Follow‐up ranged from 5 to 108 months, with a median follow‐up of 24 months. Three patients (33.3%) had local recurrence, three patients (33.3%) survived without tumors, and one patient had lung metastasis 2 years after operation, and survived with tumors. Five patients (55.6%) died, of which four died of lung metastasis and one died of brain metastasis. Survival analysis showed that the 3‐year overall survival rate was 57%. Bone grafts did not heal in four patients, and bone grafts healed in five patients. The healing time ranged from 5 to 7 months, with an average of 6.2 months. Complications: one patient developed deep infection 2 months after operation; one patient had skin edge necrosis; titanium rod loosening and displacement were found in two patients with nonunion of bone graft, and no fracture of nail rod was found. The MSTS 93 functional score of nine patients ranged from 20% to 50%, with an average of 34%.ConclusionThe tumors around the sacroiliac joint often invade the contralateral bone by ligament, and the en bloc resection and pelvic ring reconstruction for primary malignant bone tumors involving sacroiliac joint was feasible.

Pelvic Reconstruction With a Novel Three-Dimensional-Printed, Multimodality Imaging Based Endoprosthesis Following Enneking Type I + IV Resection

“…Limb-sparing surgical procedure is much more challenging and demanding in the pelvis as compared with hindquarter amputation but has been proved to be associated with comparable life expectancies, relapse-free survival, and improved QOL (quality-of-life) (1,7,25). Due to the complex three-dimensional structures of the pelvis, especially when iliosacral regions involved, tumors are frequently related to the invasion of pelvic viscera and neurovascular structures and tend to develop into considerable sizes before confirmed, which render Type I + IV resection more difficult to achieve (1,4,7,26). When the supra-acetabular region and the partial sacrum are resected, the discontinuity of the posterior pelvic girdle contributed to considerable limb shortening and decreased lumbopelvic stability if without reconstruction (19,25).…”

“…Pelvic bone tumors invading sacroiliac joint are rare, and its reconstruction after wide resection still remains one of the most technically challenging procedures (1,2). In contrast to the anatomical characteristics of extremities, pelvic tumors with occult symptoms are frequently not diagnosed until considerable tumor size (3,4). Wide oncological resection combined with adjuvant therapies has shown its therapeutic advantage over hindquarter amputation in terms of expected survival, local tumor control, and quality of life (5,6).…”

“…Wide oncological resection combined with adjuvant therapies has shown its therapeutic advantage over hindquarter amputation in terms of expected survival, local tumor control, and quality of life (5,6). With the advancements of multi-modality fusion imaging, adjuvant therapies, and three-dimensional printing technologies, various researchers have illustrated limb preservations are feasible for selected cases (1,2,4,(7)(8)(9). The main concern in reconstruction is to re-establish the continuity of the pelvic girdle and prevent the subsequent collapses or rotations of residual ilium under weight-bearing conditions and retain favorable limb functions in the long term.…”

“…Since the application of 3DMMI in the pelvic girdle reconstruction, especially in type I+IV reconstruction, are rare. Studies either focus on PRSS reconstruction (1,4) or 3D-printed endoprosthesis reconstruction for periacetabular region invading sacroiliac joint with a single modality of the image used (8,10,19). The purpose of this retrospective study was to present our experience that adopting the 3DMMI technique in reconstruction of type I+IV resection and describe the clinical outcomes, as well as complications compared with PRSS reconstruction.…”

Transarticular Invasion of Primary Bone Tumors and Tumor-Like Lesions Near the Sacroiliac Joint: an MRI Study in 128 Patients

“…Value of imaging study assessment of transarticular invasion of primary bone tumors and tumor-like lesions near the sacroiliac joint Among imaging techniques (X-ray, CT, MRI and radionuclide scans) for the assessment of bone tumors, MRI has unique advantages with respect to showing the range of intramedullary and surrounding soft tissue invasion of the bone tumor, invasion of the adjacent joints and bone metastasis [7,8]. Abnormal signal changes on MRI can not only clearly reveal the location, size and involved range of bone tumors and tumor-like lesions near the sacroiliac joint but also clearly show that a tumor destroying the ipsilateral cortical bone invades the contralateral bone of the joint across different structures of the sacroiliac joint [9].…”