Malignant Pelvic Tumors Involving the Sacrum: Surgical Approaches and Procedures Based on a New Classification

Zhang, Yidan; Guo, Wei; Yang, Ru; Tang, Xiaodong; Yan, Taiqiang; Ji, Tao

doi:10.1111/os.12240

Cited by 8 publications

(9 citation statements)

References 41 publications

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“…Zhang et al 33 proposed a new classification of Enneking type 4 resections of the sacrum. They divided the excisions and reconstructive procedures into four subtypes (a to d) according to the extent of the tumour invasion in the sacrum.…”

Section: Methodsmentioning

confidence: 99%

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Primary malignant bone tumours of spine and pelvis in children

Helenius

Krieg

2021

Journal of Children's Orthopaedics

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Purpose Axial malignant bone tumours are rare in children and adolescents, and their prognosis is still relatively poor due to non-specific symptoms, such as back or groin pain, which may result in late hospital presentation. Therefore, it is very important to raise awareness regarding this pathology. Methods We performed a narrative review, including scientific publications published in English. We searched Medline and Google Scholar databases for information on the incidence and prognosis of axial malignant bone tumours in children and adolescents (< 18 years). Outcomes of different surgical management strategies and reconstruction options were assessed. Results The incidence of primary malignant bone tumours before the age of 18 years is approximately five per one million population; around 25% of these tumours are located in the axial skeleton. With a five-year survival rate of 50%, tumours in an axial location (chest cage, spine, pelvis) are associated with a poorer prognosis than tumours in more peripheral locations. En bloc excision with clear margins has been shown to improve local control and overall survival, even though obtaining adequate surgical margins is difficult due to the close location of large neurovascular structures and other major organs. Spinal reconstruction options include instrumented fusion with allograft or expandable cage. Pelvic reconstruction is needed in internal hemipelvectomy, and the options include biological, endoprosthetic reconstructions, hip transposition, arthrodesis or creation of pseudoarthrosis and lumbopelvic instrumentation. Conclusion Early diagnosis, a timely adequate multidisciplinary management, appropriate en bloc excision, and reconstruction improve survival and quality of life in these patients. Level of Evidence V

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Section: Methodsmentioning

confidence: 99%

“…All sacral excisions will include lumbopelvic fixation with pedicle screw instrumentation. 33 When the excision also includes the acetabulum, the lumbopelvic instrumentation can be connected into a modular hemipelvic prosthesis. 6 , 9 , 16 …”

Section: Methodsmentioning

confidence: 99%

Primary malignant bone tumours of spine and pelvis in children

Helenius

Krieg

2021

Journal of Children's Orthopaedics

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“…Due to the deep location of primary bone tumors abutting the sacroiliac joint, the tumors may invade the sacroiliac joint or even cross it at the time of diagnosis. Preoperative accurate diagnosis of transarticular invasion of the sacral or iliac tumor plays an important role in the design of surgical program [1][2][3][4] . [2] For primary malignant bone tumors involving the sacroiliac joint, it is necessary to resect the ilium and sacrum invaded by the tumors together with the sacroiliac joint and to reach the safe boundary of oncology [1] .…”

Section: Introductionmentioning

confidence: 99%

“…[2] For primary malignant bone tumors involving the sacroiliac joint, it is necessary to resect the ilium and sacrum invaded by the tumors together with the sacroiliac joint and to reach the safe boundary of oncology [1] . The postsurgical recurrence rate of tumors in patients reaching the safe boundary was much lesser than that in patients not reaching the safe boundary [3][4][5] . Imaging studies of pelvic bone tumors invading the sacroiliac joint have been rarely reported in the literature [2,[6][7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

Transarticular invasion of primary bone tumors abutting the sacroiliac joint: an MRI study in 128 patients

Ding

Yin

Zhang

et al. 2020

Preprint

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Background: To investigate magnetic resonance imaging (MRI) manifestation of transarticular invasion of primary bone tumors abutting the sacroiliac joint.Methods: We conducted a retrospective analysis of MRI data in 128 patients with primary bone tumors abutting the sacroiliac joint from January 2004 to December 2015. The diagnoses were confirmed by surgical findings and pathological examination. The tumors of 87 patients located in the ilium and 41 patients in the sacrum. Tumors were divided into high-grade malignant tumor group (Group 1), low-grade (Group 2) malignant tumor group and intermediate tumor group (Group 3). Transarticular invasion routes included 3 types: across ligament (Type 1), across articular cartilage (Type 2) and across periarticular tissue (Type 3).Results: Transarticular invasion were observed in 33 patients (25.8%): Group 1 (22 patients) included 15 patients (51.7%) with conventional osteosarcoma and 7 patients (43.8%) with Ewing's sarcoma; Group 2 (5 patients) included 4 patients (11.4%) with central chondrosarcoma and 1 patient (7.7%) with chordoma; Group 3 (6 patients) included 4 patients (20.0%) with giant cell tumor of bone, 1 patient (16.7%) with chondroblastoma and 1 patient (11.1%) with aneurysmal bone cyst. The difference of transarticular invasion incidence was not statistically significant between primary iliac and sacral tumors (P > 0.05). The differences were statistically significant between group 2 and group 1, group 3 and group 1, respectively (P < 0.01). Significant differences were observed among different invasion types (P < 0.01): type 1(31 times), type 2 (15 times) and type 3 (5 times).Conclusions: MRI is sensitive and useful to evaluate transarticular invasion of primary bone tumors abutting the sacroiliac joint.

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“…Abdominal aortic balloon occlusion has been successfully implemented in controlling bleeding in sacropelvic resections [10,14,15,26,33]. Because most sacral tumors receive a blood supply from the iliolumbar arteries and the lateral sacral arteries originating from the internal iliac artery, by placing the aortic balloon cephalad to the iliac bifurcation and inflating it to an expected pressure, blood flow to the sacral tumor can be minimized [29].…”

Section: Introductionmentioning

confidence: 99%

Can Aortic Balloon Occlusion Reduce Blood Loss During Resection of Sacral Tumors That Extend Into the Lower Lumber Spine?

Zhang

Guo

Tang

et al. 2018

Clin Orthop Relat Res

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Malignant Pelvic Tumors Involving the Sacrum: Surgical Approaches and Procedures Based on a New Classification

Abstract: The proposed standardized protocols should help orthopaedic surgeons to achieve adequate margins, manage risk, achieve better oncologic and functional outcomes, and minimize perioperative complications when treating massive pelvic tumors involving the sacrum.

Cited by 8 publications

References 41 publications

Primary malignant bone tumours of spine and pelvis in children

Primary malignant bone tumours of spine and pelvis in children

Transarticular invasion of primary bone tumors abutting the sacroiliac joint: an MRI study in 128 patients

Can Aortic Balloon Occlusion Reduce Blood Loss During Resection of Sacral Tumors That Extend Into the Lower Lumber Spine?

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