Hemipelvectomias: tratamento, avaliação funcional e prognóstica dos tumores pélvicos

Abstract

Objective: To describe the experience of one single institution in internal hemipelvectomies without reconstruction and external hemipelvectomies. Methods: Twenty-one patients with primary tumors of the pelvic region underwent total hemipelvectomy, at Barretos Cancer Hospital, São Paulo, Brazil, between 2004 and July 2009. Of these, seven were treated with external hemipelvectomy (classic) and 14 with internal hemipelvectomy. Evaluation was done based on Enneking's surgical classification for internal hemipelvectomy. Results: Overall survival in two years was 63.9%. Median survival of 43 months. Functional outcomes demonstrated that procedures with innominate bone resection reached 12.5%, 62.5% and 25% of bad, good and excellent results, respectively. When innominate bone was preserved the results were 16.7% and 83.3% good and excellent, respectively. No endoprosthesis or bone graft reconstructions were done. Conclusions: Hemipelvectomy is an unusual procedure that is rarely performed because it is infrequently indicated and because of its high morbidity rate. In some reports, the morbidity rate has reached 77% of the cases. We did not perform any type of reconstruction or arthrodesis based on complications and the experience of good results with this method. Our results are similar to the main reports and are still subject of discussion by the oncologic surgeons. Level of evidence IV, Case-control study.

Outcomes following periacetabular tumor resection: A 25‐year institutional experience

“…23 Mean MSTS scores have been reported between 45% and 75.6%, while rate of complication has been reported as less than 33%. 2,[25][26][27] Carmody Soni 2 found mean MSTS scores of 63% for patients who underwent reconstruction, and 45% for those who did not. Despite which is a surgeon reported score.…”

“…Overall complication rates have been previously shown to be highest after saddle prosthesis (87%) 4,11,[13][14][15][16][17]23,28,37 followed by custom prostheses (59%). 4,14,[18][19][20][21][22] Complications following amputation 1,3,14,23,28 and resection arthroplasty 2,10,[23][24][25][26][27][28]35,38 are predominantly due to wound complications, while those experienced by patients who undergo reconstruction through use of an implant or allograftprosthetic composite [3][4][5][6][7][8][9][10]13,37 are frequently the result of fracture, dislocation, or deep infection. Historically, reconstruction utilizing allograft or allograftprosthetic composite (APC) has resulted in satisfactory functional outcomes in patients [5][6][7][8]…”

“…Limb salvage following periacetabular resection has evolved over recent years due to the growing availability of reconstructive options. Numerous studies have investigated the types of reconstruction, with options including hip transposition, [1][2][3][4] allografts, [5][6][7][8][9][10] saddle prostheses, [11][12][13][14][15][16][17] modular and custom prostheses, 11,[18][19][20][21][22] as well resection without reconstruction (resection arthroplasty), 2,[23][24][25][26][27] and amputation. 1,3,14,23,28 Resection arthroplasty on is associated with low complication and recurrence rates.…”

“…1,3,14,23,28 Resection arthroplasty on is associated with low complication and recurrence rates. 2,[23][24][25][26][27] While many studies have shown acceptable functional outcome, differences in use of walking aids and cosmetic gait have been described compared with reconstruction. 24 Reconstruction utilizing allograft, megaprostheses, or a combination of the two (ie allograft prosthetic composite [APC]) has yielded good functional preservation in large cohorts of patients, though being associated with a considerable risk of complications, including infection (19%-31%), dislocation (5%-18%), wound dehiscence (3-10%), and structural failure (1%-10%).…”

“…For all patients, internal hemipelvectomy without reconstruction was offered as a viable treatment option. Patients were counseled on an expected loss of function and lower risk of complication in the absence of internal hardware 2,[25][26][27]. Consideration of patient age, disease prognosis, and desire for a higher likelihood of having a single surgery was included in this discussion with patients.Demographic information including patient age, and sex, as well as clinical information including anatomic region of resection, reconstructive options including no reconstruction, pathologic diagnosis were collected for analysis.…”