Surgical management of pelvic bone sarcoma with internal hemipelvectomy: Oncologic and Functional outcomes

Salunke, Abhijeet Ashok; Shah, Jaymin; Warikoo, Vikas; Chakraborty, Amit; Sahijwani, Harshwardhan; Sharma, Mohit; Jha, Rohit Kumar; Dhange, Avdhoot; Pathak, Subodh Kumar; Pandit, Jyotindra; Pruthi, Manish; Pandya, Shashank; Jain, Abhishek

doi:10.1016/j.jcot.2017.04.004

Cited by 28 publications

(32 citation statements)

References 23 publications

(15 reference statements)

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“…Reconstruction to improve ambulation after resection of the wing of the ilium may include bone grafts, plates, and prostheses; however, some authors do not recommend reconstruction when the acetabulum is not resected . Good functional outcome has been noted in man without reconstruction postresection, although limb length discrepancy and decreased acetabular coverage was reported in all patients . Given the biomechanical differences between man and dog, caution should be exercised in extrapolating from human research regarding the requirement for stabilization.…”

Section: Discussionmentioning

confidence: 99%

“…The procedure described in this report is analogous to a type I internal hemipelvectomy described in human patients. 9 Reconstruction to improve ambulation after resection of the wing of the ilium may include bone grafts, plates, and prostheses 11,12,[14][15][16] ; however, some authors do not recommend reconstruction when the acetabulum is not resected. 12 Good functional outcome has been noted in man without reconstruction postresection, 19 although limb length discrepancy and decreased acetabular coverage was reported in all patients.…”

Section: Discussionmentioning

confidence: 99%

“…Fundamentally, iliectomy and ischiectomy are techniques to preserve the limbs when removing pelvic bone neoplasm . Internal hemipelvectomy for tumor removal with preservation of the limb has been well reported in human medicine . The Enneking classification for pelvic resection describes three types of procedures .…”

Section: Introductionmentioning

confidence: 99%

“…8 Internal hemipelvectomy for tumor removal with preservation of the limb has been well reported in human medicine. [9][10][11][12][13][14][15][16] The Enneking classification for pelvic resection describes three types of procedures. 9 Depending on resection of the ilium, periacetabular, or pubis, they were classified as type I, type II, or type III, respectively.…”

Section: Introductionmentioning

confidence: 99%

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Iliectomy with limb preservation for a dog with ilial osteosarcoma: Surgical description and case report

Oramas

Boston²,

Skinner

2019

Veterinary Surgery

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Objective To report the surgical technique for iliectomy and outcome in a single clinical case. Study design Case report. Animal A 10‐year‐old female spayed Rottweiler. Methods A dog presented with left pelvic limb lameness due to a mass involving the left ilium. Fine needle aspirates were indicative of a sarcoma and suspicious for osteosarcoma. Computed tomography of thorax, abdomen, and pelvis was performed as well as skeletal scintigraphy, with no evidence of metastasis seen. The dog underwent iliectomy with preservation of the ipsilateral limb and was ambulatory 24 hours after surgery. Results of histopathology confirmed the diagnosis of an osteosarcoma. Results A right ischial fracture was noted 8 days postoperatively and was conservatively managed. Local recurrence was reported 385 days postoperatively, with no overt metastatic disease revealed by computed tomography of the thorax and abdomen. The dog was euthanized because of local recurrence 430 days after surgery. Conclusion Iliectomy was well tolerated in this dog and afforded good function of the pelvic limbs. Local recurrence developed with no evidence of metastasis at the last follow‐up. Iliectomy can be considered for a mass confined to the ilium when preservation of the limb is desired. Additional studies are required to determine the local recurrence and complication rates associated with this procedure in dogs with axial skeletal osteosarcoma. Clinical significance To the authors' knowledge, this case report represents the fist surgical description and clinical outcome for an iliectomy in dogs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Iliectomy with limb preservation for a dog with ilial osteosarcoma: Surgical description and case report

Oramas

Boston²,

Skinner

2019

Veterinary Surgery

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“…Internal hemipelvectomy always leads to a weakness of the abdominal wall, including loss of pelvic floor integrity. These results, per definition, in a hernia gap . Consequently, 100% of cases result in hernias.…”

mentioning

confidence: 98%

Incarcerated hernia after internal hemipelvectomy for G2 chondrosarcoma: a preventable complication?

Baltic

Laback

Auer

et al. 2019

ANZ Journal of Surgery

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Internal hemipelvectomy: A single institution's learning curve and longitudinal experience

Vucicevic,

Zavras,

Fice

et al. 2024

Journal of Surgical Oncology

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Background and ObjectivesWide margin resection for pelvic tumors via internal hemipelvectomy is among the most technically challenging procedures in orthopedic oncology. As such, surgeon experience and technique invariably affect patient outcomes. The aim of this clinical study was to assess how an individual surgeon's experiences and advancements in technology and techniques in the treatment of internal hemipelvectomy have impacted patient outcomes at our institution.MethodsThis study retrospectively examined a single tertiary academic institution's consecutive longitudinal experience with internal hemipelvectomy for primary sarcoma or pelvic metastases over a 26‐year period between the years 1994 and 2020. Outcomes were assessed using two separate techniques. The first stratified patients into cohorts based on the date of surgery with three distinct “eras” (“early,” “middle,” and “modern”), which reflect the implementation of new techniques, including three‐dimensional (3D) computer navigation and cutting guide technology into our clinical practice. The second method of cohort selection grouped patients based on each surgeon's case experience with internal hemipelvectomy (“inexperienced,” “developing,” and “experienced”). Primary endpoints included margin status, complication profiles, and long‐term oncologic outcomes. Whole group multivariate analysis was used to evaluate variables predicting blood loss, operative time, tumor‐free survival, and mortality.ResultsA total of 72 patients who underwent internal hemipelvectomy were identified. Of these patients, 24 had surgery between 1994 and 2007 (early), 28 between 2007 and 2015 (middle), and 20 between 2016 and 2020 (modern). Twenty‐eight patients had surgery while the surgeon was still inexperienced, 24 while developing, and 20 when experienced. Evaluation by era demonstrated that a greater proportion of patients were indicated for surgery for oligometastatic disease in the modern era (0% vs. 14.3% vs. 35%, p = 0.022). Fewer modern cases utilized freehand resection (100% vs. 75% vs. 55%, p = 0.012), while instead opting for more frequent utilization of computer navigation (0% vs. 25% vs. 20%, p = 0.012), and customized 3D‐printed cutting guides (0% vs. 0% vs. 25%, p = 0.002). Similarly, there was a decline in the rate of massive blood loss observed (72.2% vs. 30.8% vs. 35%, p = 0.016), and interdisciplinary collaboration with a general surgeon for pelvic dissection became more common (4.2% vs. 32.1% vs. 85%, p < 0.001). Local recurrence was less prevalent in patients treated in middle and modern eras (50% vs. 15.4% vs. 25%, p = 0.045). When stratifying by case experience, surgeries performed by experienced surgeons were less frequently complicated by massive blood loss (66.7% vs. 40% vs. 20%, p = 0.007) and more often involved a general surgeon for pelvic dissection (17.9% vs. 37.5% vs. 65%, p = 0.004). Whole group multivariate analysis demonstrated that the use of patient‐specific instrumentation (PSI) predicted lower intraoperative blood loss (p = 0.040). However, surgeon experience had no significant effect on operative time (p = 0.125), tumor‐free survival (p = 0.501), or overall patient survival (p = 0.735).ConclusionWhile our institution continues to utilize neoadjuvant and adjuvant therapies following current guideline‐based care, we have noticed changing trends from early to modern periods. With the advent of new technologies, we have seen a decline in freehand resections for hemipelvectomy procedures, and a transition to utilizing more 3D navigation and customized 3D cutting guides. Furthermore, we have employed the use of an interdisciplinary team approach more regularly for these complicated cases. Although our results do not demonstrate a significant change in perioperative outcomes over the years, our institution's willingness to treat more complex cases likely obscures the benefits of surgeon experience and recent technological advances for patient outcomes.

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Surgical management of pelvic bone sarcoma with internal hemipelvectomy: Oncologic and Functional outcomes

Cited by 28 publications

References 23 publications

Iliectomy with limb preservation for a dog with ilial osteosarcoma: Surgical description and case report

Iliectomy with limb preservation for a dog with ilial osteosarcoma: Surgical description and case report

Incarcerated hernia after internal hemipelvectomy for G2 chondrosarcoma: a preventable complication?

Internal hemipelvectomy: A single institution's learning curve and longitudinal experience

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