Outcomes of pelvic resection from malignant pelvic tumors. A case series

Abstract

Introduction: Malignant pelvic tumors also tend to present late and therefore pose a major challenge for orthopedic oncologists because of the large tumor size, local extension, and complex anatomy with proximity to major neurovascular structures and intestinal and urinary tracts. Method: We evaluated the oncologic, functional outcome and complications following internal hemipelvectomy in a consecutive series of patients with malignant muculoskeletal tumors of the pelvis at our hospital between January 2012 and December 2017. The follow-up period was defined as the length of time elapsed from the date of surgery until the death or last date of review following operation. We analyzed survival rate using Kaplan Meier method and it relation with tumor site, tumor size, and type of histology. Result: Our clinical series of patients were composed of 4 males and 5 females. Of 9 patients, 6 cases were primary malignant bone tumor (3 cases of chondrosarcoma, 2 cases of osteosarcoma, and 1 case of Ewing's sarcoma), 2 cases of metastatic bone disease from thyroid carcinoma, 1 case from breast adenocarcinoma. The Kaplan Meier analysis showed 1 year and 2 years survival rate were 88.9% and 66.7% respectively. The functional outcomes showed the mean MSTS score 16.5 point. The lowest score was 9, which was pelvis resection type I + II on osteosarcoma case. The highest score was 25, which was pelvic resection type II + III and reconstruted with iliofemoral arthrodesis. There was 1 case intraoperative bleeding and 2 cases post operative infections. Conclusions: The majority of pelvic tumor underwent pelvic resection is chondrosarcoma. Functional outcome MSTS score was still comparable with previous study. Complications of pelvic surgeries were bleeding and infection. In our small case series, pelvic resection with wide margin and reconstruction of bone defect may give good local control and clinical outcome. Highlights:

Pelvic reconstruction with pedicle screw-rod system following pelvic resection type I/II/III in pelvic sarcoma

“…Joel et al Also concluded that although the mortality is relatively low in hemipelvectomy group, the morbidity is high including wound infection and flapnecrosis. 1,[5][6][7][8][9] Despite of difficulty in obtaining negative margin of resection, limb salvage surgery for pelvic tumors can improve patient's quality of life by reducing psychological trauma and physical disability. Limb salvage surgery by pelvic resections are challenging procedure to manage pelvic malignancies, severe trauma, and infection.…”

“…This procedure includes the resection of the involved hemipelvis which further divided into four types according to Enneking and Dunham: type I involves the ilium; type II involves the acetabulum, type III involves the ischium and pubic rami, and type IV involves sacrum. 1,[5][6][7]10,11 In our patient, the tumor was extended from ilium, ischium to the ipsilateral pubic bones owe decided to perform wide excision involving those bone by pelvic resection type I/II/III. Pelvic complex structure makes the pelvic resection is such a challenging and technically demanding surgery.…”

“…To reconstruct pelvic arch so that can over come weight while preserving some motion to gain better functional outcome must be considered which requires an adequate pre-operative planning. 1,5,6,10,12 Adequate patient-based consideration of surgical options must be made considering the lowest risk of complication and allowed most rapid rehabilitation. Biological reconstruction is commonly used although there are some risks include non union, bone graft fracture and infection.…”

“…Arthroplasty reconstructions are recommended when remaining ilium and pubis are sufficient for fixation of pelvis allograft or autograft composite with a unipolar or total hip prosthesis. 1 Zou et al recommend the use of PSRS for reconstructive surgery after I or I + IV pelvic resection and for other indications such as isolated metastasis tumor, reserving the top of the acetabulum of the pubis and sciatic after tumor excision. Their study showed that PSRS is a safe method that has rapid rehabilitation, shorter hospital stays, lower complication rates and favorable functional results with most patients achieving independent ambulation and excellent cosmetics.…”

“…Malignant tumors involving pelvic region poses major problem for orthopedic oncologists since these tumors are usually largesized, extend to pelvic visceral organs and they tend to present late. 1,2 Previously, the main stay treatment of malignant pelvic tumors was by limb ablation surgery or previously known as external hemipelvectomy. Currently with advancement of surgical techniques, chemotherapy and radiation therapy, limb salvage procedures by pelvic resection (internal hemipelvectomy) become the treatment of choice particularly if the tumor has not invaded major neuro vascular structures.…”