Complications and Cost Analysis of Hemipelvectomy for the Treatment of Pelvic Tumors

Benatto, Mariana Tedeschi; Hussein, Amira Mohamede; Gava, Nelson Fabrício; Maranho, Daniel A; Engel, Edgard Eduard

doi:10.1590/1413-785220192702206721

Cited by 7 publications

(4 citation statements)

References 18 publications

(48 reference statements)

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“…In the case series of Senchenkov et al, [12] 39% of the patients (62/160) had surgical site infection. Benatto et al [14] reported that infection rate was 36% (11/31) in their case series. In our case series, surgical site infections were observed in 34 (50.0%) patients.…”

Section: Discussionmentioning

confidence: 87%

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External and internal hemipelvectomy: A retrospective analysis of 68 cases

et al. 2022

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External and internal hemipelvectomy are rare surgical treatment methods applied in primary malignant tumors of the pelvis, pelvic metastases, infections or severe trauma. [1,2] Bone and soft tissue tumors of the pelvis are rare and difficult to treat due to the complex anatomical structure of the region. At the time of hospital admission, the tumor size is usually large and surgical treatment is difficult due to its close relationship with neurovascular, intestinal and urogenital structures. [2] The diagnosis process starts with clinical suspicion and physical examination and, then, appropriate imaging techniques are used. After the radiological work-up, a biopsy procedure is performed to identify the histopathological diagnosis. [3] The indication for internal or external hemipelvectomy is determined depending on the tumor size, stage, location, proximity to neurovascular structures and abdominal organs. [1,2,4] Internal Objectives: This study aims to investigate the factors that may be associated with surgical site infection and mortality in pelvic resection surgeries.Patients and methods: A total of 68 patients (40 males, 28 females; mean age: 43±16.2 years; range, 11 to 70 years) who underwent internal or external hemipelvectomy between January 2010 and January 2020 were retrospectively analyzed. We reviewed data concerning histopathological diagnosis, surgical technique, pelvic resection type, tumor size, postoperative infection, duration of follow-up, and mortality. Results:The mean follow-up was 45.5±42.2 months. Among 68 patients, 29 (42.6%) cases underwent external hemipelvectomy and 39 (57.4%) cases underwent internal hemipelvectomy. Reconstruction was performed in 14 (20.6%) patients who underwent internal hemipelvectomy. Of all patients, 61 had primary malignant pelvic tumors and two had metastatic pelvic tumors. Of the other five patients, two had a giant cell tumor, two had a pelvic hydatid cyst, and one had an aneurysmal bone cyst. The three most common pelvic tumors were chondrosarcoma (n=25, 36.7%), osteosarcoma (n=13, 19.1%), and Ewing sarcoma (n=8, 11.8%). Surgical site infections were observed in 34 (50.0%) patients. Of 34 patients, 15 (22.1%) had superficial infections and 19 (27.9%) had deep surgical infections. The superficial and deep infection rates were higher in the external hemipelvectomy group compared to internal hemipelvectomy (p=0.02). Patients with postoperative infection had a mean survival period of 36.0 months compared to 79.8 months in patients without infection (p=0.037). The patients treated with internal hemipelvectomy had a mean survival of 97.0 months compared to 25.7 months in patients treated with external hemipelvectomy (p<0.0001). The effect of Enneking stages of malignant pelvic tumors on survival was investigated using the Kaplan-Meier analysis. Cumulative survival decreased, as the stage progressed (p<0.0001). Conclusion:The type of surgical technique affects the possibility of postoperative infection. Postoperative infection, surgical method, and stage of the tum...

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Section: Discussionmentioning

confidence: 87%

“…In the literature, the rate of postoperative complications ranges from 20 to 62%. [1,9,10,12,14,[15][16][17][18] Surgical site infections and wound problems are the most common complications for hemipelvectomies. [1,2,16] Guder et al [4] reported that wound infection occurred in 61.7% of cases (21/34).…”

Section: Discussionmentioning

confidence: 99%

External and internal hemipelvectomy: A retrospective analysis of 68 cases

et al. 2022

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“…1 Amputations at these levels have been associated with high rates of postoperative complications including neurogenic bowel and bladder deficits, flap necrosis, wound infection, and scoliosis. [2][3][4] In addition, individuals with this level of amputation can experience unique challenges, poor quality of life, and complications secondary to difficulty with prosthesis fit, loss of residual musculature, concurrent nerve injury, and organ displacement. 1 Phantom limb pain (PLP), that is, perceived discomfort or pain interpreted as existing in a previously amputated extremity, is common after extremity amputations, reported at rates between 29% and 85%.…”

Section: Introductionmentioning

confidence: 99%

The lived experience of military beneficiaries with amputations at the hip and pelvic level

Spinuzza,

McHugh,

Garland

et al. 2024

Prosthetics &Amp; Orthotics International

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Background: Hip- and pelvic-level amputations are devastating injuries that drastically alter patient function and quality of life. This study examined the experience of military beneficiaries with a hip- or pelvic-level amputation to better characterize their challenges and specific needs and to optimize treatment in the future. Methods: We conducted a retrospective review of the Military Health System and identified 118 patients with a history of one or more amputation(s) at the hip or pelvic level between October 2001 and September 2017. Surviving participants (n = 97) were mailed a letter which explained the details of the study and requested participation in a telephonic interview. A total of six individuals (one female, five males) participated in structured interviews. Results: The study group included four participants with hip disarticulations and two participants with hemipelvectomies (one internal, one external). All six participants reported significant challenges with activities related to prosthetic use, mobility, residual limb health, pain, gastrointestinal and genitourinary function, psychiatric health, and sexual function. Conclusions: These interviews highlight the unique needs of individuals with hip- and pelvic-level amputations and may improve access to higher echelons of care that would enhance the function and quality of life for these participants.

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“…In dogs, the most frequent primary bone neoplasm is osteosarcoma, comprising 85% of diagnosed neoplasms originating from the skeleton, and is followed by chondrosarcoma, fibrosarcoma, hemangiosarcoma, giant cell tumor, liposarcoma, lymphoma, osteoma, and multiple myeloma (DALECK et al, 2006). Among these, osteosarcoma, chondrosarcoma, fibrosarcoma, and hemangiosarcoma are the most frequent malignant bone neoplasms requiring aggressive and comprehensive procedures (SCHULZ, 2014;BENATTO et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Partial hemipelvectomy: An alternative for improving dogs’ life quality

et al. 2022

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Partial hemipelvectomy refers to the surgical removal of a pelvic segment, which is performed for pelvic bone neoplasms, severe fractures, or poor bone union. This study presents the cases of seven dogs, six of which have neoplasms involving the hip joint and one with severe pelvic canal narrowing due to a poorly consolidated trauma. Partial caudal hemipelvectomy was performed for all the dogs to improve the quality of life and delay euthanasia. Of the seven cases, six required the use of a polypropylene mesh for the pelvic wall closure, with 85.71% of them acquiring manageable complications in the postoperative period. Despite these complications, an overall improvement in the quality of life was reported to be significant in the operated animals due to the removal of the cause of pain or discomfort. Thus, it was concluded that partial hemipelvectomyis beneficial for dogs with pelvic conditions. Furthermore, the main complication due to the lack of a pelvic wall for primary occlusion was circumvented by using a polypropylene mesh, showing that possible complications in this procedure can be appropriately managed.

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Complications and Cost Analysis of Hemipelvectomy for the Treatment of Pelvic Tumors

Cited by 7 publications

References 18 publications

External and internal hemipelvectomy: A retrospective analysis of 68 cases

External and internal hemipelvectomy: A retrospective analysis of 68 cases

The lived experience of military beneficiaries with amputations at the hip and pelvic level

Partial hemipelvectomy: An alternative for improving dogs’ life quality

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