Evaluation of a novel classification system to predict local recurrence in sarcoma patients undergoing hemipelvectomy with iliosacral resection

Abstract

Aims Iliosacral sarcoma resections have been shown to have high rates of local recurrence (LR) and poor overall survival. There is also no universal classification for the resection of pelvic sarcomas invading the sacrum. This study proposes a novel classification system and analyzes the survival and risk of recurrence, when using this system. Methods This is a retrospective analysis of 151 patients (with median follow-up in survivors of 44 months (interquartile range 12 to 77)) who underwent hemipelvectomy with iliosacral resection at a single centre between 2007 and 2019. The proposed classification differentiates the extent of iliosacral resection and defines types S1 to S6 (S1 resection medial and parallel to the sacroiliac joint, S2 resection through the ipsilateral sacral lateral mass to the neuroforamina, S3 resection through the ipsilateral neuroforamina, S4 resection through ipsilateral the spinal canal, and S5 and S6 contralateral sacral resections). Descriptive statistics and the chi-squared test were used for categorical variables, and the Kaplan-Meier survival analysis were performed. Results Resections were S1 in 25/151 patients (17%), S2 in 70/151 (46%), S3 in 33/151 (22%), S4 in 77/151 (11%), S5 in 4/151 (3%), and S6 in 2/151 (1%). An internal hemipelvectomy was performed in 113/151 patients (75%), and 38/151 patients (25%) had an external hemipelvectomy. The predominant types of sarcoma were high-grade osteosarcoma in 48/151 patients (32%), chondrosarcoma in 41/151 (27%), Ewing sarcoma in 33/151 (22%), pleomorphic sarcoma in 17/151 (11%), and others in 2/151 (8%). LR was found in 24/151 patients (15%) with S3, S5, with S6 resections showing the highest rate of LR (p = 0.038). Overall, 19/151 patients (16%) had evidence of metastastic disease at the time of surgery and these patients showed poorer survival when compared to patients with no metastasis. Conclusion The proposed classification can help to report and compare different surgical and reconstructive approaches in these difficult cases who are still have a considerable risk of LR. Cite this article: Bone Joint J 2022;104-B(2):290–296.

Surgical and Oncologic Outcome following Sacrectomy for Primary Malignant Bone Tumors and Locally Recurrent Rectal Cancer

“…According to Feiz-Erfan et al, the extent of resection (subtotal/total) in metastases does not influence overall survival, although there is a trend towards en bloc resection with regard to better local control [22]. Gosheger et al, however, found a significant difference in the extent of resection in patients with sacral/pelvic sarcoma [57].…”

Oncology

“…Due to its unique location and small numbers of patients presenting annually to each unit, a classification for the resection of iliac tumours which invade the sacrum has been lacking, a situation which this study from Münster (Germany) sought to remedy. 5 The team carried out a retrospective analysis of 151 patients who under-…”

“…Due to its unique location and small numbers of patients presenting annually to each unit, a classification for the resection of iliac tumours which invade the sacrum has been lacking, a situation which this study from Münster (Germany) sought to remedy. 5 The team carried out a retrospective analysis of 151 patients who underwent hemipelvectomy for the above diagnosis at a single specialist centre. Having reviewed the series, they went on to devise a six-category classification based on the relationship between the resection and the sacroiliac joints, neuroforamina, and midline.…”

Reconstruction following oncological iliosacral resection

“…This balance is difficult to achieve with tumours that require resection of the sacroiliac joint (SIJ), as these are associated with both higher rates of recurrence and poor functional outcomes. 1,2 Despite the associated perioperative morbidity and mortality, resection of locally advanced iliosacral tumours offers the potential for a cure and long-term survival. 3,4 Modern multidisciplinary approaches and classification systems for sacropelvic tumours have brought some clarity to the surgical planning process and expected functional outcomes of patients undergoing iliosacral resection.…”

“…This balance is difficult to achieve with tumours that require resection of the sacroiliac joint (SIJ), as these are associated with both higher rates of recurrence and poor functional outcomes. 1,2 Despite the associated perioperative morbidity and mortality, resection of locally advanced iliosacral tumours offers the potential for a cure and long-term survival. 3,4…”