Abstract
A paucity of data exists centering on the pain experience of children following hemipelvectomy performed for primary bone and soft tissue sarcomas. In this study, we aimed to describe the incidence, severity, and evolution of perioperative pain and function in pediatric oncology patients undergoing hemipelvectomy, and, additionally, we sought to detail the analgesic regimens used for these patients perioperatively. A retrospective chart review was conducted, studying cancer patients, aged 21 years and under, who underwent hemipelvectomy at MD Anderson Cancer Center (MDACC) from 2018 to 2021. Primary outcomes included the evolution of pain throughout the perioperative course, as well as the route, type, dose, and duration of analgesic regimens. Eight patients were included in the analysis. The mean age at operation was 13 ± 2.93 years. All patients received opioids and acetaminophen. The mean pain scores were highest on post-operative day (POD)0, POD5, and POD 30. The mean opioid use was highest on POD5. A total of 75% of patients were noted to be ambulating after hemipelvectomy. The mean time to ambulation was 5.33 ± 2.94 days. The combination of acetaminophen with opioids, as well as adjunctive regional analgesia, non-steroidal anti-inflammatory drugs, gabapentin, and/or ketamine in select patients, appeared to be an effective analgesic regimen, and functional outcomes were excellent in 75% of patients.
Highlights
Hemipelvectomy is a complex surgical procedure performed for malignant or locally aggressive pelvic bone and soft tissue tumors, and it is less commonly performed for trauma or osteomyelitis [1,2,3,4]
Six patients presented with Osteosarcoma, and two patients presented with Ewings sarcoma
Acute pain is a hallmark of pediatric pelvic sarcoma patients, occurring both at presentation and in the post-operative period following hemipelvectomy [6,19,27]
Summary
Hemipelvectomy is a complex surgical procedure performed for malignant or locally aggressive pelvic bone and soft tissue tumors, and it is less commonly performed for trauma or osteomyelitis [1,2,3,4]. Osteosarcoma and Ewing’s sarcoma are the most common malignant bone tumors of the pelvis in children that present for hemipelvectomy [6,7,8,9]. Treatment for these malignant neoplasms is multifactorial, including both systemic chemotherapy and surgery, as well as radiation therapy, depending on the specific histologic diagnosis [6]. They often encroach upon the other organs within the pelvis, such as the bowel, bladder, vagina, prostate, and/or neurovascular bundles [1,2,8] It is not entirely clear whether the worse prognosis is due to the intrinsic biology of these tumors, or to the fact that negative margins are more difficult to obtain due to the location. In select cases, both internal and external hemipelvectomy can offer a palliative approach to the management of pain, pathological fractures, infection, and fungating wounds [5]
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