Annals of Surgical Oncology

, Volume 19, Issue 13, pp 4043–4051 | Cite as

Iliosacral Resections of Pelvic Malignant Tumors and Reconstruction with Nonvascular Bilateral Fibular Autografts

  • Jin Wang
  • Qinglian Tang
  • Xianbiao Xie
  • Junqiang Yin
  • Zhiqiang Zhao
  • Zhibin Li
  • Changye Zou
  • Gang Huang
  • Jingnan Shen
Bone and Soft Tissue Sarcomas

Abstract

Background

Iliosacral resection of pelvic malignant tumors and subsequent reconstruction have tested the ingenuity of orthopedic oncologists because of the difficulty of oncological wide resection and the complex biomechanics of the sacroiliac joint render reconstruction challenging. This study compared the functional and surgical outcomes of a biological reconstruction technique with the lack of reconstruction following iliosacral resection.

Methods

Twenty-six consecutive cases with malignant iliac tumors involving the sacrum were retrospectively reviewed. These cases underwent iliosacral resection (type I/IV) followed by no reconstruction or a biological reconstruction blinded to authors between 1997 and 2007. After iliosacral resection, 12 cases underwent reconstruction with nonvascular fibular grafts and plate and/or pedicle screw-rod; the other 14 cases did not undergo reconstruction.

Results

The median follow-up was 84.42 (range, 32–165) months. The local recurrence rate in the reconstruction group was 8.33 % (1/12) with 14.29 % (2/14) in the group without reconstruction. The functional score of the biological reconstruction group was significantly higher than that of the no-reconstruction group as determined by Student’s t test. In the biological reconstruction group, bone fusion occurred in 91 % of cases and fibula hypertrophy was observed in 41.7 %. Complications included sciatic nerve palsy, broken screws, intractable pain, nonunion, pelvic oblique, and leg-length discrepancy.

Conclusions

After iliosacral resections of pelvic malignant tumors, the biologic reconstruction of these defects could restore spinopelvic stability and continuity. The double-barrel fibular autograft combined with the plate or pedicle screw-rod system is an effective reconstruction method for both optimal short- and long-term stability.

Keywords

Local Recurrence Rate Functional Score Pelvic Ring Fibular Graft Oblique Pelvis 

Notes

Acknowledgment

Supported by Sun Yat-sen University Clinical Research 5010 Program and the National Natural Science Foundation of China, serial no. 30872967, 81072193.

References

  1. 1.
    Farid YR. Decancellation sacral osteotomy in iliosacral tumor resection: a technique for precise sacral margins. Clin Orthop Relat Res. 2010;468:1362–72.PubMedCrossRefGoogle Scholar
  2. 2.
    Baliski CR, Schachar NS, McKinnon JG, Stuart GC, Temple WJ. Hemipelvectomy: a changing perspective for a rare procedure. Can J Surg. 2004;47:99–103.PubMedGoogle Scholar
  3. 3.
    Dominkus M, Darwish E, Funovics P. Reconstruction of the pelvis after resection of malignant bone tumours in children and adolescents. Recent results. Cancer Res. 2009;179: 85–111.PubMedCrossRefGoogle Scholar
  4. 4.
    Court C, Bosca L, Le Cesne A, Nordin JY, Missenard G. Surgical excision of bone sarcomas involving the sacroiliac joint. Clin Orthop Relat Res. 2006;451:189–94.PubMedCrossRefGoogle Scholar
  5. 5.
    Enneking WF, Dunham WK. Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg Am. 1978;60:731–46.PubMedGoogle Scholar
  6. 6.
    Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980:106–20.Google Scholar
  7. 7.
    Kollender Y et al. Internal hemipelvectomy for bone sarcomas in children and young adults: surgical considerations. Eur J Surg Oncol. 2000;26:398–404.PubMedCrossRefGoogle Scholar
  8. 8.
    Steel HH. Partial or complete resection of the hemipelvis. An alternative to hindquarter amputation for periacetabular chondrosarcoma of the pelvis. J Bone Joint Surg Am. 1978;60:719–30.PubMedGoogle Scholar
  9. 9.
    Beadel GP et al. Iliosacral resection for primary bone tumors: is pelvic reconstruction necessary? Clin Orthop Relat Res. 2005;438:22–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Capanna R et al. Complications of pelvic resections. Arch Orthop Trauma Surg. 1987;106:71–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Sabourin M. et al. Surgical management of pelvic primary bone tumors involving the sacroiliac joint. Orthop Traumatol Surg Res. 2009;95: 284–92.PubMedCrossRefGoogle Scholar
  12. 12.
    Somville J, Van Bouwel S. Surgery for primary bone sarcomas of the pelvis. Acta Orthop Belg. 2001;67:442–7.PubMedGoogle Scholar
  13. 13.
    Wirbel RJ, Schulte M, Mutschler WE. Surgical treatment of pelvic sarcomas: oncologic and functional outcome. Clin Orthop Relat Res. 2001:190–205.Google Scholar
  14. 14.
    Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993:241–6.Google Scholar
  15. 15.
    Masterson EL, Davis AM, Wunder JS, Bell RS. Hindquarter amputation for pelvic tumors. The importance of patient selection. Clin Orthop Relat Res. 1998:187–94.Google Scholar
  16. 16.
    Abudu A, Grimer RJ, Cannon SR, Carter SR, Sneath RS. Reconstruction of the hemipelvis after the excision of malignant tumours. Complications and functional outcome of prostheses. J Bone Joint Surg Br. 1997;79:773–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Fuchs B, O’Connor MI, Kaufman KR, Padgett DJ, Sim FH. Iliofemoral arthrodesis and pseudarthrosis: a long-term functional outcome evaluation. Clin Orthop Relat Res. 2002:29–35.Google Scholar
  18. 18.
    Khan SN, Hofer MA, Gupta MC. Lumbar degenerative scoliosis: outcomes of combined anterior and posterior pelvis surgery with minimum 2-year follow-up. Orthopedics. 2009;32.Google Scholar
  19. 19.
    Campanacci M, Capanna R. Pelvic resections: the Rizzoli Institute experience. Orthop Clin North Am. 1991;22:65–86.PubMedGoogle Scholar
  20. 20.
    Kawai A et al. Prognostic factors for patients with sarcomas of the pelvic bones. Cancer. 1998;82:851–9.PubMedCrossRefGoogle Scholar
  21. 21.
    O’Connor MI, Sim FH. Salvage of the limb in the treatment of malignant pelvic tumors. J Bone Joint Surg Am. 1989;71:481–94.PubMedGoogle Scholar
  22. 22.
    O’Connor MI. Malignant pelvic tumors: limb-sparing resection and reconstruction. Semin Surg Oncol. 1997;13:49–54.PubMedCrossRefGoogle Scholar
  23. 23.
    Hubert DM, Low DW, Serletti JM, Chang B, Dormans JP. Fibula free flap reconstruction of the pelvis in children after limb-sparing internal hemipelvectomy for bone sarcoma. Plast Reconstr Surg. 2010;125:195–200.PubMedCrossRefGoogle Scholar
  24. 24.
    Langlais F, Lambotte JC, Thomazeau H. Long-term results of hemipelvis reconstruction with allografts. Clin Orthop Relat Res. 2001:178–86.Google Scholar
  25. 25.
    Pring ME, Weber KL, Unni KK, Sim FH. Chondrosarcoma of the pelvis. A review of sixty-four cases. J Bone Joint Surg Am. 2001;83-A:1630–42.Google Scholar
  26. 26.
    Missenard G, Dubousset J, Genin J. [Large resection of the sacroiliac joint. Technique, reconstruction, anatomical and functional results]. Rev Chir Orthop Reparatrice Appar Mot. 1991;77:14–24.Google Scholar
  27. 27.
    Hugate R Jr, Sim FH. Pelvic reconstruction techniques. Orthop Clin North Am. 2006;37:85–97.PubMedCrossRefGoogle Scholar
  28. 28.
    Sakuraba M et al. Pelvic ring reconstruction with the double-barreled vascularized fibular free flap. Plast Reconstr Surg. 2005;116:1340–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Aho AJ et al. Incorporation and clinical results of large allografts of the extremities and pelvis. Clin Orthop Relat Res. 1994:200–13.Google Scholar
  30. 30.
    Mankin HJ, Doppelt S, Tomford W. Clinical experience with allograft implantation. The first ten years. Clin Orthop Relat Res. 1983:69–86.Google Scholar
  31. 31.
    Ozaki T, Hillmann A, Bettin D, Wuisman P, Winkelmann W. High complication rates with pelvic allografts. Experience of 22 sarcoma resections. Acta Orthop Scand. 1996;67:333–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Mankin HJ, Doppelt SH, Sullivan TR, Tomford WW. Osteoarticular and intercalary allograft transplantation in the management of malignant tumors of bone. Cancer. 1982;50:613–30.PubMedCrossRefGoogle Scholar
  33. 33.
    Krieg AH, Lenze U, Gaston MS, Hefti F. The outcome of pelvic reconstruction with non-vascularised fibular grafts after resection of bone tumours. J Bone Joint Surg Br. 2010;92:1568–73.PubMedGoogle Scholar
  34. 34.
    Jia YW et al. A finite element analysis of the pelvic reconstruction using fibular transplantation fixed with four different rod-screw systems after type I resection. Chin Med J (Engl). 2008;121:321–6.Google Scholar
  35. 35.
    Shin KH, Rougraff BT, Simon MA. Oncologic outcomes of primary bone sarcomas of the pelvis. Clin Orthop Relat Res. 1994:207–17.Google Scholar
  36. 36.
    Nagoya S, Usui M, Wada T, Yamashita T, Ishii S. Reconstruction and limb salvage using a free vascularised fibular graft for periacetabular malignant bone tumours. J Bone Joint Surg Br. 2000;82:1121–4.PubMedCrossRefGoogle Scholar
  37. 37.
    de Boer HH, Wood MB. Bone changes in the vascularised fibular graft. J Bone Joint Surg Br. 1989;71:374–8.PubMedGoogle Scholar
  38. 38.
    Lazar E, Rosenthal DI, Jupiter J. Free vascularized fibular grafts: radiographic evidence of remodeling and hypertrophy. AJR Am J Roentgenol. 1993;161:613–5.PubMedGoogle Scholar
  39. 39.
    El-Gammal TA, El-Sayed A, Kotb MM. Hypertrophy after free vascularized fibular transfer to the lower limb. Microsurgery. 2002;22:367–70.PubMedCrossRefGoogle Scholar
  40. 40.
    Nishida J, Shiraishi H, Okada K, Ehara S, Shimamura T. Vascularized iliac bone graft for iliosacral bone defect after tumor excision. Clin Orthop Relat Res. 2006;447:145–51.PubMedCrossRefGoogle Scholar
  41. 41.
    Rodl RW et al. Ewing’s sarcoma of the pelvis: combined surgery and radiotherapy treatment. J Surg Oncol. 2003;83:154–60.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Jin Wang
    • 1
  • Qinglian Tang
    • 1
  • Xianbiao Xie
    • 1
  • Junqiang Yin
    • 1
  • Zhiqiang Zhao
    • 1
  • Zhibin Li
    • 1
  • Changye Zou
    • 1
  • Gang Huang
    • 1
  • Jingnan Shen
    • 1
  1. 1.Muskulaskeletal Oncology Department, Department of Orthopaedic OncologyFirst Affiliated Hospital of Zhongshan UniversityGuangzhouChina

Personalised recommendations