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Internal hemipelvectomy: A single institution's learning curve and longitudinal experience.
Rajko S Vucicevic1, Athan G Zavras1,2, Michael P Fice1
1Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Journal of Surgical Oncology
|January 30, 2024
Summary
Advancements in technology and surgical techniques for internal hemipelvectomy have shifted practice towards 3D navigation and customized guides. While surgeon experience did not significantly alter outcomes, the institution
Area of Science:
- Orthopedic Oncology
- Surgical Oncology
- Medical Technology
Background:
- Internal hemipelvectomy for pelvic tumors is a complex orthopedic oncology procedure.
- Surgeon experience and technique significantly influence patient outcomes.
- Technological advancements and evolving surgical methods aim to improve outcomes.
Purpose of the Study:
- To assess the impact of surgeon experience and technological advancements on internal hemipelvectomy outcomes.
- To analyze trends in surgical techniques and patient outcomes over a 26-year period.
- To evaluate the effectiveness of new technologies like 3D computer navigation and cutting guides.
Main Methods:
- Retrospective study of 72 internal hemipelvectomy cases (1994-2020) at a single institution.
- Patients stratified by surgical era (early, middle, modern) and surgeon experience (inexperienced, developing, experienced).
- Analysis of margin status, complications, oncologic outcomes, blood loss, operative time, and survival.
Main Results:
- Modern era saw increased indications for oligometastatic disease and use of 3D navigation/cutting guides.
- Massive blood loss decreased, and interdisciplinary collaboration increased over time.
- Surgeries by experienced surgeons showed less blood loss and more collaboration; 3D navigation/guides correlated with lower blood loss.
Conclusions:
- Shift from freehand resection to 3D navigation and customized guides in internal hemipelvectomy.
- Increased use of interdisciplinary teams for complex pelvic tumor resections.
- While not statistically significant, the institution's adoption of advanced techniques and willingness to treat complex cases may obscure direct benefits of experience and technology on outcomes.
