Abstract
Pelvic resection is a technique that involves surgical resection of portions of the pelvic girdle. Hemipelvectomy is a pelvic resection that salvages an ipsilateral limb. The main indication for these procedures is primary malignant tumors of the pelvis (mostly chondrosarcomas), but in rare cases they are indicated for metastatic lesions, infection, or trauma.Objective: the main purpose of this study was to analyze pelvic resection patients.Methods: the results of treatment of 239 patients (131 male and 108 female) with pelvic tumors who were undergoing surgeries procedures in the Sytenko Institute from 1963 till 2017 were evalueted. 186 patients were operated at modern era in 2004–2017. The most frequent nosologies were chondrosarcomas, osteochondromas and secondary metastatic lesions. The average age of patients was (37.2 ± 18.9) years (7–80). Preoperative planning is crucial to define the extent of the tumor, plan the surgical margins, and identify the location of the vital structures. Necessary imaging includes plain radiography, CT, and MRI. There were 38 patients with type I resection (by Enneking and Dunham classification), 132 — with II type and 69 — with III type resection in our series.Results: reconstruction is dictated by the extent of the resection and the remaining structures. Surgical technique is dictated by histology of the tumor and location of the lesion. Allograft and autograft pelvic reconstruction has been used for patients. The TESS and MSTS have been applied to assess function outcomes. Wound infection and flap necrosis, nonunion, nerve palsy and local recurrence of malignant tumors are the most common complications for hemipelvectomies and pelvic resections.Conclusions: a multidisciplinary team is required for treat bone tumor of a pelvis. Appropriate preoperative counseling with the patient and family is paramount to explain the magnitude of the procedure, common complications, and predicted functional loss.
Highlights
Pelvic resection and hemipelvectomy are rare procedures that are used primarily in management of primary malignant tumors and, in management of metastatic tumors, severe trauma, infection
Inclusion of the sciatic buttress in the resection results in disrupted continuity of the pelvic ring; this must be restored to preserve limb length. This can be achieved with allograft, autograft, or a metallic prosthesis
The Toronto Extremity Salvage Score (TESS) and Musculoskeletal Tumor Society (MSTS) 1987 and 1993 scores were similar between the groups, and similar rates of local recurrence and survival were noted as well
Summary
Pelvic resection and hemipelvectomy are rare procedures that are used primarily in management of primary malignant tumors and, in management of metastatic tumors, severe trauma, infection. One goal of pelvic resection is limb salvage of the ipsilateral lower extremity. This procedure involves local resection of all or portions of the involved hemipelvis. Hemipelvectomy is a more ablative procedure in which the involved hemipelvis is removed in its entirety, along with the ipsilateral extremity. This procedure is known as hindquarter amputation. The first reported hemipelvectomy was performed by Billroth in 1889, the procedure was unsuccessful. In 1895, Billroth’s contemporaries Jaboulay, Caciopoli, and Girard performed the first successful hemipelvectomy [1]. In 1909, Ransohoff [2] became the first surgeon in the United States to complete the hemipelvectomy successfully
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