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Rajasekaran RB, Kurisunkal V, Stevenson JD, Parry MC, Morris GV, Jeys LM. A pictographic guide for decision making in surgery for pelvic bone sarcoma. J Orthop 2025; 60:71-77. [PMID: 39345686 PMCID: PMC11437611 DOI: 10.1016/j.jor.2024.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 09/02/2024] [Indexed: 10/01/2024] Open
Abstract
Pelvic bone sarcoma surgery is challenging due to complex anatomy, proximity to major neurovascular structures, and, more importantly, the potential for complications. Decision-making is vital in offering patients the best oncological and functional outcomes after surgery. Multidisciplinary teams involved from the stage of diagnosis and treatment planning, followed by surgery by experienced teams have proven to be beneficial. Tumour-free margin clearance is essential, and surgical planning must be tailored to achieve the same. The choice of reconstruction needs to be decided based on the amount of bone resected and the available expertise and resources. Lesions isolated only to PI or PIII region may not need reconstruction. Though pedestal cups and Custom-made prosthesis are useful in reconstruction after periacetabular tumour resections, hip transposition surgery is also widely practiced by surgeons with favourable outcomes particularly after neo-adjuvant radiotherapy/proton beam therapy. Navigation has shown promise in achieving tumour-negative margins and disease-free progression particularly in chondrosarcoma. A flap-based approach can be considered for hindquarter amputations; however, patients need to be counseled regarding the complications following this surgery. This article, with proposed flowcharts, is aimed at providing practicing surgeons with a guide toward decision-making while planning pelvic bone sarcoma surgery.
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Affiliation(s)
- Raja Bhaskara Rajasekaran
- Department of Musculoskeletal Oncology, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | | | | | | | - Guy V. Morris
- Royal Orthopaedic Hospital, Birmingham, B31 2AP, United Kingdom
| | - Lee M. Jeys
- Royal Orthopaedic Hospital, Birmingham, B31 2AP, United Kingdom
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Wang PQ, Gazendam A, Ibe I, Kim N, Alfaraidy M, Eastley N, Griffin A, Wunder J, Ferguson P, Tsoi K. Obesity increases the risk of major wound complications following pelvic resection for bone sarcoma. J Surg Oncol 2024; 130:293-300. [PMID: 38764259 DOI: 10.1002/jso.27690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Given the paucity of data, the objective of this study is to evaluate the association between obesity and major wound complications following pelvic bone sarcoma surgery specifically. METHODS Patients who underwent pelvic resection for bone sarcoma from 2005 to 2021 with a minimum 6-month follow-up were reviewed. Patients with benign tumors, primary soft tissue sarcomas, local recurrence at presentation, pelvic metastatic disease, and underweight patients were excluded. A major wound complication was defined as the need for a secondary debridement procedure. Differences in baseline demographics, surgical factors, postoperative complications, and functional outcomes were compared between obese and nonobese patients. A multivariate logistic regression was performed to identify independent risk factors for major wound complications, and a Kaplan-Meier analysis to estimate overall survival between both groups. RESULTS Of the 93 included patients, 21 were obese (body mass index ≥ 30 kg/m2). The obesity group had a significantly higher rate of major wound complication (52% vs. 26%, p = 0.034) and a lower Toronto Extremity Salvage Score at 1-year postoperatively (47.5 vs. 71.4, p = 0.025). Obesity was the only independent risk factor in the multivariate analysis. No differences in overall survival were demonstrated between groups. CONCLUSIONS Obesity is a significant risk factor for major wound complications in pelvic bone sarcoma treatment. This highlights the importance of careful perioperative optimization and wound management.
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Affiliation(s)
- Patrick Qi Wang
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Sinai Health System, Mount Sinai Hospital, Division of Orthopaedic Surgery, University of Toronto Musculoskeletal Oncology Unit, Toronto, Ontario, Canada
| | - Aaron Gazendam
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Sinai Health System, Mount Sinai Hospital, Division of Orthopaedic Surgery, University of Toronto Musculoskeletal Oncology Unit, Toronto, Ontario, Canada
| | - Izuchukwu Ibe
- Department of Orthopaedics and Rehabilitation, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Noel Kim
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Meshal Alfaraidy
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Sinai Health System, Mount Sinai Hospital, Division of Orthopaedic Surgery, University of Toronto Musculoskeletal Oncology Unit, Toronto, Ontario, Canada
| | - Nicholas Eastley
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Sinai Health System, Mount Sinai Hospital, Division of Orthopaedic Surgery, University of Toronto Musculoskeletal Oncology Unit, Toronto, Ontario, Canada
| | - Anthony Griffin
- Department of Surgery, Sinai Health System, Mount Sinai Hospital, Division of Orthopaedic Surgery, University of Toronto Musculoskeletal Oncology Unit, Toronto, Ontario, Canada
| | - Jay Wunder
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Sinai Health System, Mount Sinai Hospital, Division of Orthopaedic Surgery, University of Toronto Musculoskeletal Oncology Unit, Toronto, Ontario, Canada
| | - Peter Ferguson
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Sinai Health System, Mount Sinai Hospital, Division of Orthopaedic Surgery, University of Toronto Musculoskeletal Oncology Unit, Toronto, Ontario, Canada
| | - Kim Tsoi
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Sinai Health System, Mount Sinai Hospital, Division of Orthopaedic Surgery, University of Toronto Musculoskeletal Oncology Unit, Toronto, Ontario, Canada
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Jamshidi K, Toloue Ghamari B, Ammar W, Mirzaei A. Outcomes of ilium and iliosacral Ewing's sarcoma resection reconstructed with tibial strut allograft. Bone Jt Open 2024; 5:385-393. [PMID: 38736406 PMCID: PMC11089335 DOI: 10.1302/2633-1462.55.bjo-2024-0049.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Aims Ilium is the most common site of pelvic Ewing's sarcoma (ES). Resection of the ilium and iliosacral joint causes pelvic disruption. However, the outcomes of resection and reconstruction are not well described. In this study, we report patients' outcomes after resection of the ilium and iliosacral ES and reconstruction with a tibial strut allograft. Methods Medical files of 43 patients with ilium and iliosacral ES who underwent surgical resection and reconstruction with a tibial strut allograft between January 2010 and October 2021 were reviewed. The lesions were classified into four resection zones: I1, I2, I3, and I4, based on the extent of resection. Functional outcomes, oncological outcomes, and surgical complications for each resection zone were of interest. Functional outcomes were assessed using a Musculoskeletal Tumor Society (MSTS) score and Toronto Extremity Salvage Score (TESS). Results The mean age of the patients was 17 years (SD 9.1). At a mean follow-up of 70.8 months (SD 50), the mean functional outcomes were 24.2 points (SD 6.3) for MSTS and 81 points (SD 11) for TESS. The mean MSTS and TESS scores were associated with the iliac resection zone (< 0.001). Nine patients (20.9%) had local recurrence. The recurrence was not associated with the zone of iliac resection (p = 0.324). The two-year disease-free survival of the patients was 69.4%. The mean time to graft union was longer in patients with the I4 resection zone (p < 0.001). The complication rate was 34.9%, and nerve palsy (11.6%) was the most common. The rate of surgical complications was not associated with the resection zone. Conclusion Reconstruction using tibial strut allograft is an efficient procedure after the resection of the ilium and iliosacral ES. Functional outcomes and complications of iliac ES depend on the resection zone, and inferior outcomes could be generally expected when more segments of the pelvic ring are resected, even if it is reconstructed.
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Affiliation(s)
- Khodamorad Jamshidi
- Department of Orthopaedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Toloue Ghamari
- Department of Orthopaedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Wael Ammar
- Department of Orthopaedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Department of Orthopaedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Broida SE, Tsoi KM, Rose PS, Ferguson PC, Griffin AM, Wunder JS, Houdek MT. Reconstruction following oncological iliosacral resection. Bone Joint J 2024; 106-B:93-98. [PMID: 38160693 DOI: 10.1302/0301-620x.106b1.bjj-2023-0594.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Aims The sacroiliac joint (SIJ) is the only mechanical connection between the axial skeleton and lower limbs. Following iliosacral resection, there is debate on whether reconstruction of the joint is necessary. There is a paucity of data comparing the outcomes of patients undergoing reconstruction and those who are not formally reconstructed. Methods A total of 60 patients (25 females, 35 males; mean age 39 years (SD 18)) undergoing iliosacral resection were reviewed. Most resections were performed for primary malignant tumours (n = 54; 90%). The mean follow-up for surviving patients was nine years (2 to 19). Results Overall, 27 patients (45%) were reconstructed, while 33 (55%) had no formal reconstruction. There was no difference in the use of chemotherapy (p = 1.000) or radiotherapy (p = 0.292) between the groups. Patients with no reconstruction had a mean larger tumour (11 cm (SD 5) vs 8 cm (SD 4); p = 0.014), mean shorter operating times (664 mins (SD 195) vs 1,324 mins (SD 381); p = 0.012), and required fewer blood units (8 (SD 7) vs 14 (SD 11); p = 0.012). Patients undergoing a reconstruction were more likely to have a deep infection (48% vs 12%; p = 0.003). Nine reconstructed patients had a hardware failure, with five requiring revision. Postoperatively 55 (92%) patients were ambulatory, with no difference in the proportion of ambulatory patients (89% vs 94%; p = 0.649) or mean Musculoskeletal Tumor Society Score (59% vs 65%; p = 0.349) score between patients who did or did not have a reconstruction. The ten-year disease-specific survival was 69%, with no difference between patients who were reconstructed and those who were not (78% vs 45%; p = 0.316). There was no difference in the rate of metastasis between the two groups (hazard ratio (HR) 2.78; p = 0.102). Conclusion Our results demonstrate that SIJ reconstruction is associated with longer operating times, greater need for blood transfusion, and more postoperative infections, without any improvement in functional outcomes when compared to patients who did not have formal SIJ reconstruction.
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Affiliation(s)
- Samuel E Broida
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kim M Tsoi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter C Ferguson
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
| | - Anthony M Griffin
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
| | - Jay S Wunder
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Laitinen MK, Parry MC, Morris GV, Jeys LM. Pelvic bone sarcomas, prognostic factors, and treatment: A narrative review of the literature. Scand J Surg 2023; 112:206-215. [PMID: 37438963 DOI: 10.1177/14574969231181504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Primary sarcomas of bone are rare malignant mesenchymal tumors. The most common bone sarcomas are osteosarcoma, Ewing's sarcoma, and chondrosarcoma. The prognosis has improved over the years, but bone sarcomas are still life-threatening tumors that need a multidisciplinary approach for diagnosis and treatment. Bone sarcomas arising in the pelvis present a unique challenge to orthopedic oncologists due to the absence of natural anatomical barriers, the close proximity of vital neurovascular structures, and the high mechanical demands placed on any pelvic reconstruction following the excision of the tumor. While radiotherapy has an important role especially in Ewing's sarcoma and chemotherapy for both Ewing's sarcoma and osteosarcoma, surgery remains the main choice of treatment for all three entities. While external hemipelvectomy has remained one option, the main aim of surgery is limb salvage. After complete tumor resection, the bone defect needs to be reconstructed. Possibilities to reconstruct the defect include prosthetic or biological reconstruction. The method of reconstruction is dependent on the location of tumor and the surgery required for its removal. The aim of this article is to give an insight into pelvic bone sarcomas, their oncological and surgical outcomes, and the options for treatment based on the authors' experiences.
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Affiliation(s)
- Minna K Laitinen
- Helsinki University Hospital and University of Helsinki Helsinki Finland Bridge Hospital Haartmaninkatu 4 PL 370 00029 HUS
- The Royal Orthopaedic Hospital, Birmingham, UK
| | - Michael C Parry
- The Royal Orthopaedic Hospital, Birmingham, UK
- The Royal Orthopaedic Hospital, Birmingham, UK
| | - Guy V Morris
- The Royal Orthopaedic Hospital, Birmingham, UK
- The Royal Orthopaedic Hospital, Birmingham, UK
| | - Lee M Jeys
- The Royal Orthopaedic Hospital, Birmingham, UK
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Yamamoto N, Araki Y, Tsuchiya H. Joint-preservation surgery for bone sarcoma in adolescents and young adults. Int J Clin Oncol 2023; 28:12-27. [PMID: 35347494 PMCID: PMC9823050 DOI: 10.1007/s10147-022-02154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/07/2022] [Indexed: 01/11/2023]
Abstract
Bone sarcoma often occurs in childhood, as well as in adolescents and young adults (AYAs). AYAs differ from pediatric patients in that their bone is skeletally mature and the physis has almost disappeared with the completion of growth. Although AYAs spend less time outside, they often participate in sports activities, as well as driving, working, and raising a family, which are natural activities in daily living. Multidisciplinary approaches involving imaging, multi-agent chemotherapy, surgical procedures, and careful postoperative care has facilitated an increase in limb-sparing surgery for bone sarcoma. In addition, recent advances in imaging modalities and surgical techniques enables joint-preservation surgery, preserving the adjacent epiphysis, for selected patients following the careful assessment of the tumor margins and precise tumor excision. An advantage of this type of surgery is that it retains the native function of the adjacent joint, which differs from joint-prosthesis replacement, and provides excellent limb function. Various reconstruction procedures are available for joint-preserving surgery, including allograft, vascularized fibula graft, distraction osteogenesis, and tumor-devitalized autografts. However, procedure-related complications may occur, including non-union, infection, fracture, and implant failure, and surgeons should fully understand the advantages and disadvantages of these procedures. The longevity of the normal limb function for natural activities and the curative treatment without debilitation from late toxicities should be considered as a treatment goal for AYA patients. This review discusses the concept of joint-preservation surgery, types of reconstruction procedures associated with joint-preservation surgery, and current treatment outcomes.
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Affiliation(s)
- Norio Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takaramachi, Kanazawa-city, Ishikawa 920-8641 Japan
| | - Yoshihiro Araki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takaramachi, Kanazawa-city, Ishikawa 920-8641 Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takaramachi, Kanazawa-city, Ishikawa 920-8641 Japan
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Worawongsakul R, Steinmeier T, Lin YL, Bauer S, Hardes J, Hecker-Nolting S, Dirksen U, Timmermann B. Proton Therapy for Primary Bone Malignancy of the Pelvic and Lumbar Region - Data From the Prospective Registries ProReg and KiProReg. Front Oncol 2022; 12:805051. [PMID: 35251976 PMCID: PMC8888414 DOI: 10.3389/fonc.2022.805051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/11/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE/OBJECTIVES Multimodality treatments together with local proton therapy (PT) are commonly used in unresectable primary bone malignancies in order to provide better tumor control rate while maintaining good feasibility. The aim of this study is to provide data on outcome of PT for the challenging cohort of pelvic and lumbar bone tumors. METHODS AND MATERIALS This retrospective study includes all patients with primary bone malignancy of the pelvis and lumbar spine receiving PT in our institution between May 2013 and December 2019 enrolled in the prospective registries KiProReg and ProReg collecting information on demographics, treatment, tumor characteristics, toxicities, and outcome. RESULTS Eighty-one patients were enrolled with a median age of 19.7 years (1.3-85.8). The median follow-up time was 27.5 months (1.2-83.2). The majority of patients was male (64.2%), ECOG status of 0-1 (75.2%), underwent only biopsy (50.6%), received chemotherapy (69.1%) and was assigned for definite PT (70.4%). The predominant tumor characteristics were as follows: Ewing's sarcoma histology (58%), negative nodal involvement (97.5%) and no metastasis at diagnosis (81.5%). Median maximal diameter of tumor was 8 cm (1.4-20). LC, EFS and OS rate were 76.5, 60, and 88.1% at two years and 72.9, 45.7, and 68.9% at three years, respectively. Age over 20 years was a significant negative factor for LC, EFS, and OS. Metastatic disease at initial diagnosis affected OS and ECOG status of 2-4 affected EFS only. Regarding 17 relapsed cases (21%), isolated distant relapse was the most common failure (46.9%) followed by local failure (40.6%). Eleven out of 14 evaluable patients relapsed within high-dose region of radiotherapy. Acute grade 3-4 toxicity was found in 41 patients (50.6%) and all toxicities were manageable. Late grade 3 toxicity was reported in 7 patients (10.4%) without any of grade 4. Most common higher grade acute and late side effects concerned hematologic and musculoskeletal toxicity. CONCLUSION Proton therapy resulted in good oncological outcomes when being part of the multimodality treatment for pelvic and lumbar primary bone malignancies. However, distant metastases and local failures within the high-dose region of radiotherapy are still a common issue. Acute and late toxicities of combined therapy were acceptable.
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Affiliation(s)
- Rasin Worawongsakul
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen, Essen, Germany
- Radiation Oncology Unit, Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- West German Cancer Centre Network, Essen, Germany
| | - Theresa Steinmeier
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen, Essen, Germany
- West German Cancer Centre Network, Essen, Germany
| | - Yi-Lan Lin
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen, Essen, Germany
- West German Cancer Centre Network, Essen, Germany
| | - Sebastian Bauer
- West German Cancer Centre Network, Essen, Germany
- Department of Medical Oncology, Sarcoma Center, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Essen, Germany
| | - Jendrik Hardes
- West German Cancer Centre Network, Essen, Germany
- German Cancer Consortium (DKTK), Essen, Germany
- Department of Orthopedic Oncology, University Hospital Essen, Essen, Germany
| | - Stefanie Hecker-Nolting
- Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart Olgahospital, Stuttgart, Germany
| | - Uta Dirksen
- West German Cancer Centre Network, Essen, Germany
- German Cancer Consortium (DKTK), Essen, Germany
- Pediatrics III (Hematology, Oncology, Immunology, Cardiology, Pulmonology), University Hospital Essen, Essen, Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen, Essen, Germany
- West German Cancer Centre Network, Essen, Germany
- German Cancer Consortium (DKTK), Essen, Germany
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Ji T, Chin BZJ, Tang X, Yang R, Guo W. Iliosacral Bone Tumor Resection Using Cannulated Screw-Guided Gigli Saw - A Novel Technique. World J Surg Oncol 2021; 19:243. [PMID: 34399773 PMCID: PMC8369724 DOI: 10.1186/s12957-021-02349-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
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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Affiliation(s)
- Tao Ji
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China
| | - Brian Z J Chin
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China.,University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, Singapore, National University Health System, Singapore, Singapore
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China
| | - Rongli Yang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China
| | - Wei Guo
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China.
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Chondrosarcoma Arising from the Posterior Iliac Crest Extending into the Spinal Canal. Case Rep Orthop 2021; 2021:5510075. [PMID: 34336329 PMCID: PMC8313319 DOI: 10.1155/2021/5510075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/01/2021] [Indexed: 11/17/2022] Open
Abstract
Chondrosarcoma is a malignant tumor characterized by the production of a cartilage matrix. Extension into the spinal canal from the extracannular space is seen mainly for neurogenic tumors, but it is rare in nonneurogenic tumors. A 75-year-old woman suffered from sciatic pain and numbness in her lower left extremity. The diagnosis was of a low-grade conventional chondrosarcoma, which originated from the posterior ilium with an intraspinal extension at the level of the sacrum, compressing the cauda equina. The tumor extended further into the S1 sacral anterior foramen, in the shape of a dumbbell. The tumor was resected in several blocks posteriorly, and the dumbbell-shaped tumor in the S1 foramen was resected by widening the S1 foramen from behind. The posterior extension of the iliac tumor seemed prevented by the posterior sacroiliac ligament, and the tumor extended into the canal. Here, we report that the iliac chondrosarcoma extending into the spinal canal is rare for this tumor type. An understating of the tumor extension is important for planning the surgical strategy.
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10
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Sakamoto A, Otsuki B, Tanida S, Fujibayashi S, Matsuda S. Preserving the Pelvic Ring at the Sciatic Notch During Resection of Malignant Bone Tumors at the Posterior Ilium. Orthop Surg 2020; 12:2013-2017. [PMID: 33043564 PMCID: PMC7767675 DOI: 10.1111/os.12783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 11/30/2022] Open
Abstract
Resection of malignant bone tumors in the posterior ilium may result in pelvic ring disruption. Preserving the pelvic ring and keeping an adequate surgical margin is ideal, but is challenging, especially when the tumor extends to the sacroiliac joint. The current report proposes a line from the lateral point of the second sacral dorsal foramen to the anterior surface of sacral ala (S2‐sacral ala line), and cutting from the line to the ilium over the sciatic notch and to the sacral wing using thread saws. This preserves the cortex at the sciatic notch and the distal sacroiliac joint. Two posterior iliac tumors extending to the sacroiliac joint, a metastatic melanoma in a 75‐year‐old male, and an osteosarcoma in a 56‐year‐old male were resected. The resections were performed along the S2‐sacral ala line, and consequently lumbo‐sacro‐pelvic fusions were performed. Both patients were able to walk with one crutch. Indications for the method using the S2‐sacral ala line for iliac tumors may be limited. However, the method can increase pelvic ring preservation in cases with posterior iliac malignant bone tumors.
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Affiliation(s)
- Akio Sakamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shimei Tanida
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Gupta S, Griffin AM, Gundle K, Kafchinski L, Zarnett O, Ferguson PC, Wunder J. Long-term outcome of iliosacral resection without reconstruction for primary bone tumours. Bone Joint J 2020; 102-B:779-787. [PMID: 32475244 DOI: 10.1302/0301-620x.102b6.bjj-2020-0004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Iliac wing (Type I) and iliosacral (Type I/IV) pelvic resections for a primary bone tumour create a large segmental defect in the pelvic ring. The management of this defect is controversial as the surgeon may choose to reconstruct it or not. When no reconstruction is undertaken, the residual ilium collapses back onto the remaining sacrum forming an iliosacral pseudarthrosis. The aim of this study was to evaluate the long-term oncological outcome, complications, and functional outcome after pelvic resection without reconstruction. METHODS Between 1989 and 2015, 32 patients underwent a Type I or Type I/IV pelvic resection without reconstruction for a primary bone tumour. There were 21 men and 11 women with a mean age of 35 years (15 to 85). The most common diagnosis was chondrosarcoma (50%, n = 16). Local recurrence-free, metastasis-free, and overall survival were assessed using the Kaplan-Meier method. Patient function was evaluated using the Musculoskeletal Tumour Society (MSTS) and Toronto Extremity Salvage Score (TESS). RESULTS At a mean follow-up of 159 months (1 to 207), 23 patients were alive without disease, one was alive with lung metastases, one was alive following local recurrence, four were dead of disease, and three had died from other causes. The overall ten-year survival was 77%. There was only one (3%) local recurrence, which occurred at 26 months. There were 18 complications in 17 patients; 13 wound healing complications/infections, three fractures, one pulmonary embolism, and one dislocation of the hip. Most complications occurred early. The mean functional scores were 21.1 (SD 8.1) for MSTS-87, 67.3 (SD 23.9) for MSTS-93 and 76.2 (SD 20.6) for TESS. CONCLUSION Patients requiring Type I or Type I/IV pelvic resections can expect a good oncological outcome and a high rate of local control. Complications are generally acute in nature and are easily manageable. These patients achieved a good functional outcome without the need for bony reconstruction. Cite this article: Bone Joint J 2020;102-B(6):779-787.
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Affiliation(s)
- Sanjay Gupta
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Anthony M Griffin
- University Musculoskeletal Unit, Mount Sinai Hospital, Toronto, Canada.,Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
| | - Kenneth Gundle
- Oregon Health & Science University, Portland, Oregon, USA
| | - Lisa Kafchinski
- Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Oren Zarnett
- University Musculoskeletal Unit, Mount Sinai Hospital, Toronto, Canada
| | - Peter C Ferguson
- Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
| | - Jay Wunder
- University Musculoskeletal Unit, Mount Sinai Hospital, Toronto, Canada
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12
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Restoration of Spinopelvic Continuity with the Free Fibula Flap after Limb-Sparing Oncologic Resection Is Associated with a High Union Rate and Superior Functional Outcomes. Plast Reconstr Surg 2020; 146:650-662. [DOI: 10.1097/prs.0000000000007095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Guided Pelvic Resections in Tumor Surgery. Tech Orthop 2018. [DOI: 10.1097/bto.0000000000000299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Kiiski J, Kuokkanen HO, Kääriäinen M, Kaartinen IS, Pakarinen TK, Laitinen MK. Clinical results and quality of life after reconstruction following sacrectomy for primary bone malignancy. J Plast Reconstr Aesthet Surg 2018; 71:1730-1739. [PMID: 30236876 DOI: 10.1016/j.bjps.2018.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/02/2018] [Accepted: 08/19/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Sacrectomy is a rare and demanding surgical procedure that results in major soft tissue defects and spinopelvic discontinuity. No consensus is available on the optimal reconstruction algorithm. Therefore, the present study evaluated the results of sacrectomy reconstruction and its impact on patients' quality of life (QOL). METHODS A retrospective chart review was conducted for 21 patients who underwent sacrectomy for a primary bone tumour. Patients were divided into groups based on the timing of reconstruction as follows: no reconstruction, immediate reconstruction or delayed reconstruction. QOL was measured using the EQ-5D instrument before and after surgery in patients treated in the intensive care unit. RESULTS The mean patient age was 57 (range 22-81) years. The most common reconstruction was gluteal muscle flap (n = 9) and gluteal fasciocutaneous flap (n = 4). Four patients required free-tissue transfer, three latissimus dorsi flaps and one vascular fibula bone transfer. No free flap losses were noted. The need for unplanned re-operations did not differ between groups (p = 0.397), and no significant differences were found for pre- and post-operative QOL or any of its dimensions. DISCUSSION Free flap surgery is reliable for reconstructing the largest sacrectomy defects. Even in the most complex cases, surgery can be safely staged, and final reconstruction can be carried out within 1 week of resection surgery without increasing peri‑operative complications. Sacrectomy does not have an immoderate effect on the measured QOL.
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Affiliation(s)
- Juha Kiiski
- Department of Plastic Surgery, Helsinki University Central Hospital, Helsinki, Finland; Division of Plastic Surgery, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland.
| | - Hannu O Kuokkanen
- Department of Plastic Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Minna Kääriäinen
- Division of Plastic Surgery, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
| | - Ilkka S Kaartinen
- Division of Plastic Surgery, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland; Department of Plastic and Reconstructive Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Toni-Karri Pakarinen
- Division of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
| | - Minna K Laitinen
- Division of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland; Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
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15
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Zhang Y, Guo W, Tang X, Yang R, Ji T, Yang Y, Wang Y, Wei R. En bloc resection of pelvic sarcomas with sacral invasion: a classification of surgical approaches and outcomes. Bone Joint J 2018; 100-B:798-805. [PMID: 29855246 DOI: 10.1302/0301-620x.100b6.bjj-2017-1212.r1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The sacrum is frequently invaded by a pelvic tumour. The aim of this study was to review our experience of treating this group of patients and to identify the feasibility of a new surgical classification in the management of these tumours. Patients and Methods We reviewed 141 patients who, between 2005 and 2014, had undergone surgical excision of a pelvic tumour with invasion of the sacrum. In a new classification, pelvisacral (Ps) I, II, and III resections refer to a sagittal osteotomy through the ipsilateral wing of the sacrum, through the sacral midline, or lateral to the contralateral sacral foramina, respectively. A Ps a resection describes a pelvic osteotomy through the ilium and a Ps b resection describes a concurrent resection of the acetabulum with osteotomies performed through the pubis and ischium or the pubic symphysis. Within each type, surgical approaches were standardized to guide resection of the tumour. Results The mean operating time was 5.2 hours (sd 1.7) and the mean intraoperative blood loss was 1895 ml (sd 1070). Adequate margins were achieved in 112 (79.4%) of 141 patients. Nonetheless, 30 patients (21.3%) had local recurrence. The mean Musculoskeletal Tumor Society (MSTS93) lower-limb function score was 68% (sd 19; 17 to 100). According to the proposed classification, 92 patients (65%) underwent a Ps I resection, 33 patients (23%) a Ps II resection, and 16 (11%) patients a Ps III resection. Overall, 82 (58%) patients underwent a Ps a resection and 59 (42%) patient a Ps b resections. The new classification predicted surgical outcome. Conclusion We propose a comprehensive classification of surgical approaches for tumours of the pelvis with sacral invasion. Analysis showed that this classification helped in the surgical management of such patients and had predictive value for surgical outcomes. Cite this article: Bone Joint J 2018;100-B:798-805.
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Affiliation(s)
- Y Zhang
- Musculoskeletal Tumor Center, Beijing Key Laboratory for Musculoskeletal Tumors, Peking University People's Hospital, Beijing, China
| | - W Guo
- Musculoskeletal Tumor Center, Beijing Key Laboratory for Musculoskeletal Tumors, Peking University People's Hospital, Beijing, China
| | - X Tang
- Musculoskeletal Tumor Center, Beijing Key Laboratory for Musculoskeletal Tumors, Peking University People's Hospital, Beijing, China
| | - R Yang
- Musculoskeletal Tumor Center, Beijing Key Laboratory for Musculoskeletal Tumors, Peking University People's Hospital, Beijing, China
| | - T Ji
- Musculoskeletal Tumor Center, Beijing Key Laboratory for Musculoskeletal Tumors, Peking University People's Hospital, Beijing, China
| | - Y Yang
- Musculoskeletal Tumor Center, Beijing Key Laboratory for Musculoskeletal Tumors, Peking University People's Hospital, Beijing, China
| | - Y Wang
- Musculoskeletal Tumor Center, Beijing Key Laboratory for Musculoskeletal Tumors, Peking University People's Hospital, Beijing, China
| | - R Wei
- Musculoskeletal Tumor Center, Beijing Key Laboratory for Musculoskeletal Tumors, Peking University People's Hospital, Beijing, China
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