Surgical Excision of Bone Sarcomas Involving the Sacroiliac Joint

Abstract

Adequate (wide or marginal and uncontaminated) margins and reconstruction are difficult to achieve when performing an internal hemipelvectomy for bone sarcomas involving the sacroiliac joint. We evaluated whether adequate surgical margins could be achieved and if functional outcomes could be predicted based on the type of resection and reconstruction. Forty patients had resections of the sacroiliac joint. Vertical sacral osteotomies were through the sacral wing (n = 2), ipsilateral sacral foramina (n = 27), sacral midline (n = 9), or contralateral foramina (n = 2). Iliac resections were Type I, Type I-II with partial or total acetabular re-section, or Type I-II-III. Surgical margins were adequate in 28 of 38 patients (74%), two (7%) of whom experienced local recurrence, compared with seven of 10 (70%) patients with inadequate margins. Reconstruction consisted of restoring continuity between the spine and pelvis. Resection of the entire acetabulum and removal of the lumbosacral trunk were the two main determinants of function, as assessed using the Musculoskeletal Tumor Society score. There were no life-threatening or function-threatening complications. Internal hemipelvectomy with a limb salvage procedure can be achieved with adequate surgical margins in selected patients. Functional outcomes can be predicted based on the type of resection and reconstruction, which helps the surgeon plan the procedure and inform the patient.

Evaluation of blood loss during limb salvage surgery for pelvic tumours

“…Tumour size, location, local recurrence, reconstruction technique, grade of malignancy, duration of the procedure and surgical margin were thought to have an influence on oncological and functional outcomes of pelvic tumours [3,4,8,20,24,26]. Additionally, blood vessel control could reduce bleeding during tumour surgery.…”

Surgical treatment of primary malignant tumors of the sacrum

“…In case when the tumor extends through the sacroilliac joint to the iliac bone the eccentric sacrectomy should be combined with hemipelvectomy 54 . In this case in their opinion the proper surgical approach is the lateral decubitus position 60 .…”

Three-dimensional reconstruction of extremity tumor regions by CT and MRI image data fusion for subject-specific preoperative assessment and planning

“…As planned preoperatively, we stripped the tumor from the lateral side, and the branches of the superior gluteal vessels and the communicating branch could be clearly exposed and ligated, enabling easy removal of the tumor without a large hemorrhage or injury to the sciatic nerve. The 3D model of patient 1's chordoma assisted in the classification of the tumor as stage IIB [20], so a 2-mm margin of resection from the tumor edges was simulated preoperatively [13]. Marginal resection for this chordoma was successfully achieved, reliably reproducing the preoperative simulation.…”

“…Then, different tumor stripping methods were tried in order to achieve full exposure of peritumoral structures. Marginal resection was planned for the chondroid chordoma in patient 1, and the planned resection margin was determined as 2 mm from the tumor edges [13]. Finally, after removal of the tumor, 3D models of peritumoral structures were again inspected by changing different angles to further perceive the structural relations.…”