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Internal hemipelvectomy for bone sarcomas in children and young adults: surgical considerations
Y Kollender1, S Shabat, J Bickels
1The National Unit of Orthopedic Oncology, in four different hospitals in Israel, Israel.
Insights
Internal hemipelvectomy is a viable limb-sparing surgery for pelvic bone sarcomas in young patients, preserving quality of life. This approach demonstrated a 22% local recurrence rate and maintained walking ability in most patients.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Orthopedic Oncology
Background:
- Pelvic bone sarcomas in pediatric and young adult populations are rare, aggressive, and associated with poor prognoses and high local recurrence rates.
- Limb-sparing surgery, specifically internal hemipelvectomy, is crucial for maintaining quality of life by avoiding amputations.
- Surgical challenges in resection and reconstruction of the pelvis in this age group are significant.
Purpose of the Study:
- To evaluate the surgical outcomes and functional results of internal hemipelvectomy for pelvic bone sarcomas in children and young adults.
- To assess the feasibility and effectiveness of limb-sparing surgery in this rare oncological condition.
- To analyze the impact of internal hemipelvectomy on quality of life and functional status.
Main Methods:
- A retrospective review of 27 patients (ages 2-22) with pelvic bone sarcomas treated between 1988 and 1998.
- All patients underwent internal hemipelvectomy and received neoadjuvant and adjuvant chemotherapy and radiotherapy.
- Tumor location, surgical type (Enneking classification), reconstruction methods, and complications were recorded.
Main Results:
- Internal hemipelvectomy was performed in all 27 patients, with various tumor involvement patterns (types I, II, III, IV, I+IV).
- Reconstruction was necessary in 15 patients; four wound infections occurred, managed successfully.
- The local recurrence rate was 22%, and most patients maintained walking ability, with 23 achieving excellent, good, or fair functional status (AMSTS).
Conclusions:
- Internal hemipelvectomy is an achievable and justified surgical option for pelvic bone sarcomas in pediatric and young adult patients, significantly improving quality of life.
- The limb-sparing approach allows for functional preservation, including walking ability, in the majority of cases.
- Further research is needed to enhance reconstructive techniques for the pelvis following oncological resection.
Aims:
Pelvic bone sarcomas in children and young adults are rare, and associated with a poor prognosis and a high rate of local recurrence. Primary goals of treatment include prevention of local recurrence and distant metastases. A secondary goal is maintenance of quality of life by avoiding major amputative surgery. This is why internal hemipelvectomy (a limb-sparing surgery) is advocated whenever possible. The focus of our presentation is surgical issues in the context of resection and reconstruction of the pelvis in the first two decades of life.
Materials And Methods:
Between January 1988 and June 1998, 27 patients were treated and operated on (follow-up time 1.5-12 years). There were 17 males and 10 females. Their age ranged between 2 and 22 years. There were 24 patients with Ewing's sarcoma (ES) and three with other bone sarcomas. In 19 patients the tumour involved the entire or part of the iliac bone (in some cases with extension to the sacrum). In five patients the tumour involved the pubis and/or ischium. In three patients the tumour involved the sacrum with some extension to the posterior iliac bone. All patients received neoadjuvant and adjuvant chemotherapy and radiotherapy with different protocols (related to the origin of referral).
Results:
Twenty-seven patients underwent internal hemipelvectomy. According to Enneking's classification there were: type I-10; type II-one; type III-six; type IV-five (including one localized sacrectomy); type I+IV-five patients. In 15 patients some kind of reconstruction was needed and in 12 no reconstruction was done. Four wound infections occurred that were managed successfully by surgical debridement, antibiotics and local wound care. In one case removal of the 'implant' was needed. No primary or secondary amputations were performed in the series. The rate of local recurrence was 22%. Functional status at the last follow-up visit or before death, according to the AMSTS functional rating system: excellent-six; good-17; fair-three and poor-one. All patients except the one poor result maintained their walking ability during the follow-up time.
Conclusions:
Internal hemipelvectomy is achievable in most cases and justified for better quality of life in children, adolescents and young adults with sarcomas. Further efforts are needed to improve the reconstructive options in the pelvis.