Internal Hemipelvectomy for Pelvic Sarcomas Using a T-incision Surgical Approach

Abstract

Internal hemipelvectomy is performed for pelvic sarcomas when the tumor can be safely resected without sacrificing the entire extremity. Wide exposure and awareness of major neurovascular structures are crucial to the success of this surgery. Various modifications on the standard utilitarian approach have been used to best achieve these goals. We reviewed our experience using the T-incision technique for 30 pelvic sarcoma resections. The minimum followup was 3.6 months (mean, 55 months; range, 3.6-185.4 months). Postoperative complications included minor complications (requiring no surgery or a simple incision and drainage with primary closure) in 27% of patients and major complications (involving a deep infection or more extensive surgical treatment) in 17%. Ninety-two percent of wound complications healed uneventfully with antibiotics and incision and drainage.The 2-, 5-, and 10-year patient survival rates were 67%, 59%, and 53%. The 2-, 5-, and 10-year disease-free survival rates were 68%, 42%, and 42%. The mean Musculoskeletal Tumor Society and Toronto Extremity Salvage Scores were 69% and 86%, respectively. We believe the T-incision technique for internal hemipelvectomy is an effective surgical approach for pelvic sarcomas when limb salvage is possible.

Hemipelvectomias: tratamento, avaliação funcional e prognóstica dos tumores pélvicos

“…In the patients submitted to hemipelvectomy without reconstruction we observed greater limb discrepancy with resection of the innominate bone that reaches 6 to 10 cm on average as described in the majority of articles. 12 The functional results of our group in the hemipelvectomies without reconstruction encourage the orthopedic oncologist to execute the procedure. We identified low rates of infection (23.8%) and, undoubtedly, a lower operating cost.…”

“…The survival of patients with pelvic tumors at our institution is very similar to the other studies published at national level. 12 The peculiarity of our hospital in receiving patients from Brazilian states that do not offer adequate healthcare support exacerbates the prognosis and hinders the indication of preservative surgery. For this reason, 1/3 of our patients were submitted to disarticulation of the hemipelvis.…”

Bilateral internal hemipelvectomy for osteosarcoma in a pediatric patient previously treated for rhabdomyosarcoma

“…Compared to other anatomical sites, surgical treatment of pelvic sarcomas shows higher rates of local recurrence and complications and a lower functional outcome [1]. Reconstruction methods are challenging and have to focus additionally on the growing skeleton in the pediatric patients [2,3].…”

“…Internal hemipelvectomy involves local resection of all or part of the hemipelvis while preserving the ipsilateral lower extremity [1]. It is indicated for management of tumors involving the pelvis that require resection but do not involve the major neurovascular structures of the lower extremity, so that a functional extremity can be preserved [2,3].…”

Blood Loss and Massive Transfusion in Patients Undergoing Major Oncological Surgery: What Do We Know?

“…Postoperative mortality varies from 0 to 8% [76][77][78][79][80][81][82][83][84]. As expected, intraoperative hemorrhage can be significant during these procedures with reported blood loss ranging from 400 cc to 12,100 cc [80,82,83,[85][86][87][88][89].…”