J Korean Orthop Assoc.  2016 Aug;51(4):294-300. 10.4055/jkoa.2016.51.4.294.

Surgical and Oncological Outcome of Pelvis Bone Tumor Patients with Type III Internal Hemipelvectomy

• Jeon DG
• Cho WH
• Song WS
• Kong CB
• Lee SY
• Kim BS

• KMID: 2348635
• DOI: http://doi.org/10.4055/jkoa.2016.51.4.294

Abstract

PURPOSE
It is generally accepted that bony reconstruction after type III (pubic) internal pelvectomy is not necessary. However, technical problems in type III resection, functional outcome according to the extent of resection, and the usefulness of synthetic material to decrease the risk of hernia has not been well addressed.
MATERIALS AND METHODS
Fifteen patients who underwent type III internal pelvectomy were extracted and the pathologic diagnosis, Enneking's stage, location of tumor and size, operation time, amount of transfusion, surgical margin, local recurrence, distant metastasis, and functional outcomes were analyzed according to the extent of resection.
RESULTS
Pathologic diagnosis was chondrosarcoma in 9, Ewing's sarcoma in 3, metastatic carcinoma in 2, and osteosarcoma in 1 patient. There were 4 patients with local recurrence and one with concomitant lung metastasis. Average Musculoskeletal Tumor Society functional score was 26.7. According to the extent of resection, functional score of 7 cases with unilateral both rami (6) or ischium (1) resection was 26, 4 cases with unilateral both rami and partial contralateral pubic ramus resection was 25, and 4 cases with unilateral both rami including ischium was 24. Two patients had tumor related complication. One patient with a huge intrapelvic tumor aroused at the symphysis pubis showed urethral invasion at presentation, therefore, urethral resection and permanent suprapubic cystostomy was inevitable. The other patient with bilateral pubic ramus involvement by tumor showed caudal displacement of the uterus after pregnancy (4 years after primary resection). She underwent Caesearian section for delivery.
CONCLUSION
Regardless of the extent of pubic bone resection, functional outcome was similar. The risk of abdominal or pelvic organ hernia was minimal even without the use of artificial material for soft tissue reconstruction; however, when the extent of resection crosses the symphysis pubis, selective application of an additional procedure to reinforce the pelvic floor may be considered.

Keyword

pelvic neoplasms; hemipelvectomy; treatment outcome

MeSH Terms

Chondrosarcoma
Cystostomy
Diagnosis
Hemipelvectomy*
Hernia
Humans
Ischium
Lung
Neoplasm Metastasis
Osteosarcoma
Pelvic Floor
Pelvic Neoplasms
Pelvis*
Pregnancy
Pubic Bone
Recurrence
Sarcoma, Ewing
Treatment Outcome
Uterus

Figure

• 

  Figure 1 (A) Preoperative plain radiograph of a 19-year-old female. Tumor involved both rami and contralateral ramus. (B) She experienced caudal displacement of uterus and bladder after pregnancy. She underwent Caeserian resection for delivery.

• 

  Figure 2 (A) Preoperative coronal magnetic resonance imaging of a 49-year-old female. She underwent hysterectomy at a referral center during biopsy. (B) The tumor arose at the symphysis pubis and entrapped the urethra. (C) Postoperative plain radiograph. Permanent cystostomy was perfomed due to urethra invasion.

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