En bloc resection of pelvic sarcomas with sacral invasion

Zhang, Y; Guo, Wei; Tang, Xiaodong; Yang, Rongli; Ji, Tao; Yang, Yi; Wang, Y; Wei, Ran

doi:10.1302/0301-620x.100b6.bjj-2017-1212.r1

Cited by 21 publications

(17 citation statements)

References 33 publications

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“…However, the positive margin rate may potentially be further decreased if the proposed CSGS technique are used in conjunction with computer-assisted techniques, thereby improving both identification of planned osteotomy site and execution of bony cutting. The overall local recurrence in the current study was 20% among the range of literature reported recentl y[ 1 , 14 , 21 ]. One patient (no.…”

Section: Discussionsupporting

confidence: 49%

“…Resections were classified according to the Peking University classificatio n[ 1 ] of surgical approaches for pelvic tumors with sacral invasion (Fig. 1 ): Briefly, pelvisacral (Ps) I, II, and III resections refer to sagittal osteotomies through the ipsilateral wing of the sacrum, through the sacral midline, or lateral to the contralateral sacral foramina, respectively.…”

Section: Methodsmentioning

confidence: 99%

“…Inadequate margin is more often at sacral side due to sacral anatomy and surgical exposur e[ 9 ]. Local recurrence was reported to be 21-47% when iliosacral tumors infiltrated the sacru m[ 1 , 10 , 11 ]. As such, tumor resections involving the sacroiliac joint require meticulous preoperative planning, effective and precise osteotomy of affected bone ensuring maximal preservation of neurovascular structures, and holistic postoperative care with regular follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Iliosacral Bone Tumor Resection Using Cannulated Screw-Guided Gigli Saw - A Novel Technique

Chin

Tang

et al. 2021

World J Surg Onc

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Background Adequate margins are technically difficult to achieve for malignant tumors involving the sacroiliac joint due to limited accessibility and viewing window. In order to address the technical difficulties faced in iliosacral tumor resection, we proposed a technique for precise osteotomy, which involved the use of canulated screws and Gigli saw (CSGS) that facilitated directional control, anteroposterior linkage of resection points and adequate surgical margins. The purpose of the current study was to evaluate whether CSGS technique facilitated sagittal osteotomy at sacral side, and were adequate surgical margins achieved? Also functional and oncological outcomes was determined along with the noteworthy complications. Methods From April 2018 to November 2019, we retrospectively reviewed 15 patients who underwent resections for primary tumors of pelvis or sacrum necessitating iliosacral joint removal using the proposed CSGS technique. Chondrosarcoma was the most common diagnosis. The osteotomy site within sacrum was at ipsilateral ventral sacral foramina in 8 cases, midline of sacrum in 5 cases, and contralateral ventral sacral foramina and sacral ala with 1 case each. The average intraoperative blood loss was 3640 mL (range, 1200 and 6000 mL) with a mean operation duration of 7.4 hours (range, 5 to 12 hours). The mean follow-up was 23.0 months (range, 18 and 39 months) for alive patients. Results Surgical margins were wide in 12 patients (80%), wide-contaminated in 1 patient (6.7%), and marginal in 2 patients (13.3%). R0 resection was achieved in 12 (80%) patients and R1 resection in 3 patients. There were three local recurrences (20%) occurred at a mean time of 11 months postoperatively. No local recurrence was observed at sacral osteotomy. The overall one-year and three-year survival rate was 86.7% and 72.7% respectively.Complications occurred in three patients. Conclusions The current study demonstrated that CSGS technique for tumor resection within the sacrum and pelvis was feasible and can achieve ideal resection accuracies. The use of CSGS was associated with high likelihood of negative margin resections in the current series. Intraoperative use of CSGS appeared to be technically straightforward and allowed achievement of planned surgical margins. It is worthwhile to consider the use of CSGS technique in resection of pelvic tumors with sacral invasion and iliosacral tumors, however further follow-up at mid to long-term is warranted to observe local recurrence rate.

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Section: Discussionsupporting

confidence: 49%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Iliosacral Bone Tumor Resection Using Cannulated Screw-Guided Gigli Saw - A Novel Technique

Chin

Tang

et al. 2021

World J Surg Onc

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“…Since 1978, Steel reported limb salvage procedure with internal pelvic resection and femoral head (FH) exclusion for the first time, and with the advances in imaging, surgery, anesthesiology, and prosthesis, limb salvage therapy was gradually being applied to the treatment of malignant pelvic bone tumors 1. However, the high rate of recurrence and complications has remained troubling 2–5. Apart from the surgeons’ technical level, a more important reason lies in the fact that surgeons need to build the tumor and its adjacent structures in the brain with each separate image, such as roentgenogram, computed tomography (CT) scan, and magnetic resonance imaging (MRI), which may result in inaccurate resection and reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Improved virtual surgical planning with 3D-multimodality image for malignant giant pelvic tumors

Fang

Xiong

et al. 2018

CMAR

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We sought to assess the early clinical outcome of 3D-multimodality image (3DMMI)based virtual surgical planning for resection and reconstruction of malignant giant pelvic tumors. Patients and methods: In this retrospective case-control study, surgery was planned and performed with 3DMMI-based patient-specific instruments (PSI) in 13 patients with giant pelvic malignancy and without 3DMMI-based PSI in the other 13 patients. In the 3DMMI group, 3DMMI was utilized, taking advantages of computed tomography (CT), contrast-enhanced CT angiography (CTA), contrast-enhanced magnetic resonance imaging (MRI), contrast-enhanced magnetic resonance neurography (MRN), which could reveal the whole tumor and all adjacent vital structures. Based on these 3DMMI, virtual surgical planning was conducted and the corresponding PSI was then designed. The median follow-up was 8 (3-24) months. The median age at operation was 37.5 (17-64) years. The mean tumor size in maximum diameter was 13.3 cm. Surgical margins, intraoperative and postoperative complications, duration of surgery, and intra-operative blood loss were analyzed. Results: In the non-3DMMI group, the margins were wide in six patients (6/13), marginal in four (4/13), wide-contaminated in two (2/13), and intralesional in one (1/13). In the 3DMMI group, the margins were wide in 10 patients (10/13), marginal in three (3/13), and there were no wide-contaminated or intralesional margins. The 3DMMI group achieved shorter duration of surgery (P=0.354) and lower intraoperative blood loss (P=0.044) than the non-3DMMI group. Conclusion: The 3DMMI-based technique is advantageous to obtain negative surgical margin and decrease surgical complications related to critical structures injury for malignant giant pelvic tumor.

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“…MRI images were mapped to CT images through affine and diffeomorphic registration algorithm, which were all implemented in open- 1D, E) and then exported to stereolithographic (STL) format and opened in a workstation running Reverse Engineering (RE) software Creo Parametric 2.0 (Parametric Technology Co., USA) to identify the characteristics for the resection margin and cut plane. In this study, the minimum tumor-free margin of 20 mm in bone were regarded as sufficient as indicated by a series of studies reporting the satisfactory tumor-free margin ranging from 5 to 15 mm and 20 mm for chondrosarcoma (21)(22)(23) and osteosarcoma with sensitive response to neoadjuvant chemotherapy (24). The cut plane was then designed with a minimum 20-mm margin to the tumor with comprehensive consideration of surgical approach, tumor-free requirement, avoidance of neurovascular injury and viscera organs, feasibility to the installation of the patient-specific instrument (PSI).…”

Section: Endoprosthesis Design With 3dmmi Techniquementioning

confidence: 99%

Pelvic Reconstruction With a Novel Three-Dimensional-Printed, Multimodality Imaging Based Endoprosthesis Following Enneking Type I + IV Resection

Zhang

Fang

et al. 2021

Front. Oncol.

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Background and PurposePelvic tumor involving Type I + IV resections are technically challenging, along with various reconstructions methods presenting unsatisfactory outcomes and high complication rates. Since predominating studies preferred adopting pedicle screw-rod system (PRSS) to address this issue, we designed a novel three-dimensional-printed, multimodality imaging (3DMMI) based endoprosthesis with patient-specific instrument (PSI) assistance to facilitate the surgical reconstruction of pelvic tumor involving Enneking Type I + IV resection. We aimed to investigate the clinical effectiveness of this novel endoprosthesis and compare it with PRSS in Type I + IV reconstruction.MethodsWe retrospective studied 28 patients for a median follow-up of 47 months (range, 10 to 128 months) in this study with either 3D-printed endoprosthesis reconstruction (n = 10) or PRSS reconstruction (n = 18) between January 2000 and December 2017. Preoperative 3DMMI technique was used for tumor evaluation, PSI design, virtual surgery, and endoprosthesis fabrication. Clinical, oncological outcomes, functional assessments, and complications were analyzed between the two groups.ResultsMinor surgical trauma with mean operative duration of 251 ± 52.16 minutes (p = 0.034) and median intraoperative hemorrhage of 2000ml (range, 1600, 4000ml) (p = 0.032) was observed in endoprosthesis group. Wide margins were achieved in 9 patients of the endoprosthesis group compared with 10 in the PRSS group (p = 0.09). The 1993 version of the Musculoskeletal Tumor Society score (MSTS-93) was 23.9 ± 3.76 in endoprosthesis group, which was higher than PRSS group (p = 0.012). No statistical significance was found in relapse between two groups (p = 0.36). Complications were observed in two patients in endoprosthesis group compared with 12 patients in PRSS group (p = 0.046).ConclusionThe novel design of this 3D-printed endoprosthesis, together with 3DMMI and PSI assisted, is technically accessible with favorable clinical outcomes compared with PRSS. Further study is essential to identify its long-term outcomes.

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En bloc resection of pelvic sarcomas with sacral invasion

Cited by 21 publications

References 33 publications

Iliosacral Bone Tumor Resection Using Cannulated Screw-Guided Gigli Saw - A Novel Technique

Iliosacral Bone Tumor Resection Using Cannulated Screw-Guided Gigli Saw - A Novel Technique

Improved virtual surgical planning with 3D-multimodality image for malignant giant pelvic tumors

Pelvic Reconstruction With a Novel Three-Dimensional-Printed, Multimodality Imaging Based Endoprosthesis Following Enneking Type I + IV Resection

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