2016, Number 3
<< Back Next >>
Acta Ortop Mex 2016; 30 (3)
Surgical treatment of malignant primary tumors of the pelvis on Enneking’s zone II
González-Pérez AM, Arvinius C, García-Coiradas J, García-Maroto R, Cebrian-Parra JL
Language: Spanish
References: 34
Page: 132-137
PDF size: 412.41 Kb.
ABSTRACT
Introduction: Surgical treatment of malignant bone tumors of the pelvis with periacetabular involvement is constantly evolving. Even though acetabular reconstructions improve quality of life without impairing cancer control, they are not complication free. Our purpose is to describe the functional outcomes and surgical complications of different reconstructive techniques for Enneking zone II tumors.
Material and methods: Fifteen patients underwent surgery for malignant pelvic bone tumors between 2002 and 2012. Seven patients were retrospectively evaluated according to the Enneking and Dunham classification and were found to have periacetabular involvement, as follows: 3 were type II; 1 types I + II; 2 types II + III, and one types I + II + III. Five patients had a standard chondrosarcoma and 2 osteosarcoma. Patients included 4 males and 3 females; mean age was 43 years. The minimum follow-up period was 12 months (mean 6.14 years). All of them underwent cancer resection with periacetabular reconstruction: massive osteochondral allograft in 3 patients, structural allograft and hip arthroplasty in 2 patients, and prosthesis with iliac anchoring in 2. They were clinically, radiologically and functionally evaluated with the MSTS scale (1993).
Results: The mean MSTS score 6 months after surgery was 20.71 (69%). Five patients (71.4%) had surgical complications: 2 dislocations of the native femoral head on the allograft; one
aseptic prosthetic dislodgement, and 2 deep infections. All patients had free intraoperative borders.
Conclusions: Acetabular reconstructions after oncologic resection for malignant bone tumors seem to provide good functional outcomes. However, only selected cases should undergo surgeries associated with a high complication rate.
REFERENCES
SECOT: Manual de cirugía ortopédica y traumatología. 2.a ed. Madrid: Médica Panamericana; 2010.
Schajowikcz F: Tumores y lesiones óseas pseudotumorales de huesos y articulaciones. Buenos Aires: Ed. Panamericana; 1982.
Huth JF, Eckardt JJ, Pignatti G, Eilber FR: Resection of malignant bone tumors of the pelvic girdle without extremity amputation. Arch Surg. 1988; 123(9): 1121-4.
Steel HH: Partial or complete resection of the hemipelvis. An alternative to hindquarter amputation for periacetabular chondrosarcoma of the pelvis. J Bone Joint Surg Am. 1978; 60(6): 719-30.
O’Connor MI, Sim FH: Salvage of the limb in the treatment of malignant pelvic tumors. J Bone Joint Surg Am. 1989; 71(4): 481-94.
Laffosse JM, Pourcel A, Reina N, Tricoire JL, Bonnevialle P, Chiron P, et al: Primary tumor of the periacetabular region: resection and reconstruction using a segmental ipsilateral femur autograft. Orthop Traumatol Surg Res. 2012; 98(3): 309-18.
Harrington KD: The use of hemipelvic allografts or autoclaved grafts for reconstruction after wide resections of malignant tumors of the pelvis. J Bone Joint Surg Am. 1992; 74(3): 331-41.
Uchida A, Myoui A, Araki N, Yoshikawa H, Ueda T, Aoki Y: Prosthetic reconstruction for periacetabular malignant tumors. Clin Orthop Relat Res. 1996; (326): 238-45.
Van der Lei B, Hoekstra HJ, Veth RP, Ham SJ, Oldhoff J, Schraffordt-Koops H: The use of the saddle prosthesis for reconstruction of the hip joint after tumor resection of the pelvis. J Surg Oncol. 1992; 50(4): 216-9.
O’Connor MI: Malignant pelvic tumors: limb-sparing resection and reconstruction. Semin Surg Oncol. 1997; 13(1): 49-54.
Rudert M, Holzapfel BM, Pilge H, Rechl H, Gradinger R: Partial pelvic resection (internal hemipelvectomy) and endoprosthetic replacement in periacetabular tumors. Oper Orthop Traumatol. 2012; 24(3): 196-214.
Enneking WF, Dunham WK: Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg Am. 1978; 60(6): 731-46.
Tomeno B: Procédés de reconstruction après résection totale ou partielle d’un hémibassin dans le traitement des tumeurs malignes de l’os iliaque. A propos de 33 cas. Rev Chir Orthop Reparatrice Appar Mot. 1987; 73 (Suppl 2): 95-8.
Conrad E, Springfiel D, Peabody T: Pelvis. In: Simon MA, Springfield D ed.: Surgery for bone and soft-tissue tumors. Philadelphia: Lippincott-Raven Publishers; 1998: 323-41.
Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ: A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993; (286): 241-6.
Griesser MJ, Gillette B, Crist M, Pan X, Muscarella P, Scharschmidt T, et al: Internal and external hemipelvectomy or flail hip in patients with sarcomas: quality-of-life and functional outcomes. Am J Phys Med Rehabil. 2012; 91(1): 24-32.
Grimer RJ, Chandrasekar CR, Carter SR, Abudu A, Tillman RM, Jeys L: Hindquarter amputation: is it still needed and what are the outcomes? Bone Joint J. 2013; 95-B(1): 127-31.
Kawai A, Healey JH, Boland PJ, Lin PP, Huvos AG, Meyers PA: Prognostic factors for patients with sarcomas of the pelvic bones. Cancer. 1998; 82(5): 851-9.
Enneking WF: Local resection of malignant lesions of the hip and pelvis. J Bone Joint Surg Am. 1966; 48(5): 991-1007.
Erikson U, Hjelmstedt A: Limb-saving radical resection of chondrosarcoma of the pelvis. J Bone Joint Surg Am. 1976; 58(4): 568-70.
Ritacco LE, Milano FE, Farfalli GL, Ayerza MA, Muscolo DL, Aponte-Tinao LA: Accuracy of 3-D planning and navigation in bone tumor resection. Orthopedics. 2013; 36(7): e942-e950.
Krettek C, Geerling J, Bastian L, Citak M, Rücker F, Kendoff D, et al: Computer aided tumor resection in the pelvis. Injury. 2004; 35 Suppl 1: S-A79-83.
Hüfner T, Kfuri M Jr, Galanski M, Bastian L, Loss M, Pohlemann T, et al: New indications for computer-assisted surgery: tumor resection in the pelvis. Clin Orthop Relat Res. 2004; (426): 219-25.
Docquier PL, Paul L, Cartiaux O, Delloye C, Banse X: Computer-assisted resection and reconstruction of pelvic tumor sarcoma. Sarcoma. 2010; 2010: 125162.
Delloye C, Banse X, Brichard B, Docquier PL, Cornu O: Pelvic reconstruction with a structural pelvic allograft after resection of a malignant bone tumor. J Bone Joint Surg Am. 2007; 89(3): 579-87.
Ozaki T, Hillmann A, Bettin D, Wuisman P, Winkelmann W: High complication rates with pelvic allografts. Experience of 22 sarcoma resections. Acta Orthop Scand. 1996; 67(4): 333-8.
Hillmann A, Hoffmann C, Gosheger G, Rödl R, Winkelmann W, Ozaki T: Tumors of the pelvis: complications after reconstruction. Arch Orthop Trauma Surg. 2003; 123(7): 340-4.
Jaiswal PK, Aston WJ, Grimer RJ, Abudu A, Carter S, Blunn G, et al: Peri-acetabular resection and endoprosthetic reconstruction for tumours of the acetabulum. J Bone Joint Surg Br. 2008; 90(9): 1222-7.
Hu YC, Huang HC, Lun DX, Wang H: Resection hip arthroplasty as a feasible surgical procedure for periacetabular tumors of the pelvis. Eur J Surg Oncol. 2012; 38(8): 692-9.
Kusuzaki K, Shinjo H, Kim W, Nakamura S, Murata H, Hirasawa Y: Resection hip arthroplasty for malignant pelvic tumor. Outcome in 5 patients followed more than 2 years. Acta Orthop Scand. 1998; 69(6): 617-21.
Falkinstein Y, Ahlmann ER, Menendez LR: Reconstruction of type II pelvic resection with a new peri-acetabular reconstruction endoprosthesis. J Bone Joint Surg Br. 2008; 90(3): 371-6.
Renard AJ, Veth RP, Schreuder HW, Pruszczynski M, Keller A, van Hoesel Q, et al: The saddle prosthesis in pelvic primary and secondary musculoskeletal tumors: functional results at several postoperative
intervals. Arch Orthop Trauma Surg. 2000; 120(3-4): 188-94.
Fisher NE, Patton JT, Grimer RJ, Porter D, Jeys L, Tillman RM, et al: Ice-cream cone reconstruction of the pelvis: a new type of pelvic replacement: early results. J Bone Joint Surg Br. 2011; 93(5): 684-8.