Results of surgical resection in pelvic Ewing's sarcoma

Abstract

Surgery provides good local control and oncologic outcomes with acceptable function in these patients.

Infection After Surgical Resection for Pelvic Bone Tumors: An Analysis of 270 Patients From One Institution

“…The 20% infection rate in our series of patients is lower than reported rates in some series [3,4,18,26,27,36,39,41,45,46] and greater or comparable to the experience reported in other studies [1,8,12,13,19,20,29,30,38] ( Table 3). The overall infection rate in many series varied from 10% to 47% after internal hemipelvectomy [1, 3, 4, 8, 10, 12, 13, 18-20, 23, 25-27, 29, 30, 34, 36, 38-41, 45, 46], whereas it ranged from 11% to 38% in patients who had resection and endoprosthetic reconstruction [1,3,12,19,20,26,27,36,45,46].…”

“…There is no unanimous opinion regarding the appropriate treatment of deep infection. Puri et al [38] reported that three (of four) infections resolved after wound lavage. One patient with ipsilateral femur autograft and prosthetic implant achieved healing of an infection with extensive, early débridement and lavage and appropriate antibiotic therapy [29].…”

“…In our series, we found that only the presence of pelvic reconstruction was statistically significant at multivariate analysis as an independent prognostic factor on infection. Puri et al [38] reported their experience for 26 patients with nonmetastatic Ewing's sarcoma of the pelvis treated with surgical resection, with an infection rate of 19% (four patients including one patient with sepsis and omental gangrene who died during the immediate perioperative period). They attributed this low incidence of infection to the fact that 50% of their patients did not undergo any form of reconstruction.…”

“…Only age older than 50 years was found to be a significant negative predictor of postoperative complications [18]. Moreover, homogeneous series of chemosensitive histologic diagnoses (Ewing's sarcoma or osteosarcoma) in the pelvis showed an incidence of postoperative infection or wound healing problems ranging from 19% to 31% despite that all patients received chemotherapy and/or radiation [38]. In our series, even if the treatment with chemotherapy and/or radiation showed a statistically significant difference at univariate analysis, it lost its significance at multivariate analysis as an independent prognostic factor of infection.…”

“…In our series, an association between the rate of infection and type of resection (periacetabular versus other types) was not found. Despite the similar complication rate, Puri et al did not reconstruct any of the resections that excluded the acetabulum [38], whereas others advocate restoring the pelvic ring after Type I or Types I to IV pelvic resections [6,41]. In our series, half of the patients with Type I or Types I to IV pelvic resections underwent reconstruction because of a massive bone defect and pelvic instability to avoid complications, including a shortened limb or limb discrepancy, pain, and diastasis of the symphysis pubis.…”