Internal hemipelvectomy, a limb saving procedure, NCI experience

ABSTRACT

Treatment of primary malignant tumors involving the pelvic girdle traditionally necessitated the sacrifice of a healthy lower extremity. Internal hemipelvectomy offers a safe alternative to this problem. With careful selection, the lower limb can be salvaged with acceptable function and hip stability. This study comprised 40 patients with malignant tumors of the pelvic bone treated by different types of internal hemipelvectomy at the National Cancer Institute [NCI], Cairo University in the period extending from 1996 to 2005. According to the location and extent of their tumors, they were ascribed to one of three groups. Group A included 28 patients who underwent type I hemipelvectomy [iliac bone resection], Group B included 8 patients who underwent type I+II hemipelvectomy [iliac and peri-acetabular resection] and group C included 4 patients who underwent type III hemipelvectomy [pubic bone resection]. The mean age for groups A, B and C was 35 +/- 11.9, 39 +/- 17.8 and 33.5 +/- 13 years; respectively. The study comprised 14 patients with Ewing's sarcoma, 12 patients with chondrosarcoma, 6 patients with osteosarcoma, 4 patients with giant cell tumor, 2 patients with aneurysmal bone cysts and 2 patients with malignant fibrous histocytoma. Neoadjuvant chemotherapy was given to 11 patients and 7 received preoperative chemotherapy and radiotherapy; whereas 22 patients received no neoadjuvant treatment. The mean +/- SD duration of the surgical procedure was 2.67 +/- 0.32 hours and the mean +/- SD intra-operative blood loss was 1323 +/- 233 ml. The difference between groups A, B, and C was statistically significant [p <0.05]. Intra-operative complications were encountered in 9 patients where 5 patients had various nerve injuries, 2 patients had vascular injury and 2 had bladder injury. In the postoperative period, 4 patients developed deep vein thrombosis, 7 showed wound infection, 3 had deep pelvic infection and 2 developed hematuria secondary to intra-operative bladder injury. Upon evaluation of the functional results obtained, 50% of the patients were judged to have good results and 30% had fair results and ambulation aids could be discarded after 6-8 months. The remaining 20%, who had undergone type I+II hemipelvectomy, demonstrated a poor functional result in the form of flail hip. At a median follow-up of 18 months, 70% of the patients were alive and free of disease, 17.5% were alive with loco-regional recurrence and 5 died; 3 from lung metastases and 2 of unrelated causes. Internal hemipelvectomy can achieve limb salvage in most cases of pelvic tumors without compromise to surgical margins, local control or survival rates. Functional results obtained with this technique were quite satisfactory when the hip joint could be preserved