The purpose of this study is to compare functional results of hemipelvectomy and internal hemipelvectomy following resection of pelvic tumours. The emotional acceptance of such surgery is also examined. From 1998 to 2003, 19 male and 13 female patients, aged from 6 to 76 years, underwent hemipelvectomy, and 12 male and seven female patients, aged from 13 to 65 years, underwent internal hemipelvectomy. In the series as a whole, follow-up ranged from 1 to 156 months. Five patients with external hemipelvectomy, six with internal hemipelvectomy and one who underwent internal hemipelvectomy followed by external hemipelvectomy were evaluated functionally, clinically and psychologically. Patients expressed emotional concern about body image and mobility. Psychosocial adjustment was difficult for all patients, but some were able to overcome their difficulties more easily than others. Patients with internal hemipelvectomy rather than external hemipelvectomy had more difficulty adjusting emotionally. The site of the tumour and morbidity rates, which remain high when limb-sparing surgery is performed for pelvic tumours, are important considerations when deciding upon the type of surgery. Patients and their families need extensive preoperative psychological preparation and postoperative psychotherapy is imperative

Purpose. Curative treatment of malignancies in the sacrum and lumbar spine frequently requires en-bloc spinopelvic resection. There is no standard classification of these procedures. We present a classification of these resections based on analysis of 45 consecutive cases of oncologic spinopelvic resections. This classification implies a surgical approach, staging algorithm, bony and soft tissue reconstruction, and functional outcomes following surgery. Method. We reviewed oncologic staging, surgical resections, and reconstructions of 45 consecutive patients undergoing spinopelvic resection with curative intent. Mean follow-up of surviving patients was 38 months. Common themes in these cases were identified to formulate the surgical classification. Results. Tumors included chondrosarcoma (n=11), other sarcomas (n=11), osteosarcoma (n=9), chordoma (n=6), locally invasive carcinoma (n=5), and others (n=3). Resections could be divided into 5 types based on the exent of the lumbosacral resection and the need for an associated external hemipelvectomy. Type 1 resections included a total sacrectomy +/− lumbar spine resection. Type 2 resections included hemisacrectomy +/− partial lumbar excision, and iliac wing resection. Type 3 resections encompassed external hemipelvectomy with hemisacrectomy +/− partial lumbar excision. Type 4 resections encompassed external hemipelvectomy with total sacrectomy +/− lumbar excision. Type 5 excisions involved hemicorporectomy type procedures. For each type of resection we have developed guidelines for trans- vs retroperitoneal surgical approaches, staging of the resections, bony and soft tissue reconstructive procedures to re-establish spinopelvic continuity, and predicted functional outcomes for patients. At mean 38 month follow-up on surviving patients, 28 are living and 17 are deceased. Twenty-two of 28 surviving patients are disease free. Nineteen of 26 surviving patients are independent in their activities of daily living. Conclusion. En bloc spinopelvic resections may be classified into five types based on the extent of lumbosacral excision and the need for concurrent hemipelvectomy. Using this classification system, we have formulated treatment strategies to guide surgical approach, procedural staging, bony and soft tissue reconstructive procedures, and expected functional outcomes. Long term survival and independent function can be achieved in this challenging patient population

Curative treatment of malignancies in the sacrum and lower lumbar spine frequently requires en bloc spinopelvic resection. There is no standard classification of these procedures. We present outcomes and a classification scheme with oncologic and reconstructive guidelines for spinopelvic tumors based on an analysis of 30 cases of en bloc resection and reconstruction performed with curative intent. Mean follow-up of surviving patients was 38 months. Tumors included osteosarcoma (n=9), chondrosarcoma (n=6), chordoma (n=5), other sarcomas (n=5), neurogenic tumors (n=4), and local extension of carcinoma (n=1). Resections could be divided into 4 types. Type 1 resections (n=12) included a total sacrectomy with lower lumbar spine and bilateral medial iliac resections. Type 2 resections (n=6) included hemisacrectomy, partial lumbar spine excision, and medial iliac resection. Type 3 resections (n=9) encompassed external hemipelvectomy with hemisacrectomy and partial lumbar spine excision. Type 4 resections (n=3) encompassed external hemipelvectomy, total sacrectomy, and lumbar spine excision. For each resection type, we have developed staged surgical approaches to allow resection with wide margins and reconstruction of spinopelvic continuity. Tumor free margins were achieved in all cases. Perioperative mortality was 3/30. Seven additional patients have died of disease, two died of other causes, two are alive with disease, and 16 have no evidence of disease. 13/18 surviving patients are independent in their activities of daily living. In our practice en bloc excision and reconstruction of spinopelvic neoplasms may be classified into four types. For each type, we have devised surgical treatment guidelines to allow for wide resection and reconstruction of spinopelvic continuity. Long term survival and independent function can be achieved in this challenging patient population. This represents the first standardised classification of oncologic spinopelvic resections and reconstructions

The purpose of this study was to evaluate the functional and oncological outcome of recycled autograft reconstruction after a wide excision for primary malignant bone tumor around the hip. From 1998 to 2015, 67 patients with a primary malignant bone tumor involving proximal femur or periacetabular zone (P2) were included. There were 36 males and 31 females with a mean age of 34 years (13 to 58). Of these, 29 patients had grade I or II chondrosarcoma, 28 high-grade osteosarcoma, 6 Ewing's sarcoma and 4 undifferentiated pleomorphic sarcoma. Enneking stage of all 67 patients was stage II. Of the resection classification, proximal femur resection was performed in 29 patients, P1+P2 in 15, P2+P3 in 14, P1+P2+P3 in 4, P2 only in 4, and P2+proximal femur in 1. Extracorporeally irradiated recycled autograft and liquid nitrogen frozen autograft were performed in 44 and 23 patients, respectively. At a mean follow-up of 98 months (10 to 239), 48 patients (72%) were continuously disease-free, 12 (18%) died of disease and 7 (10%) were alive with disease. The tumors of these patients who had died of disease were usually located in pelvic bones (10/12). Of these 37 patients with pelvic tumors, 7 patients (22%) had local recurrence, four of them received external hemipelvectomy. Other complications included hip dislocation in 2 patients, nerve injury in 2 and deep infection in 2. However, the above complications were rarely occurred in the patients with proximal femur reconstruction. The mean Musculoskeletal Tumor Society functional score were 77% (53 to 93). Recycled autograft reconstruction for primary malignant bone tumor around the hip is a valid method with acceptable morbidity and a favorable functional outcome

Ten to 15% of the pelvic girdle tumors are primary malignant bone tumors, while about 80% are osseous metastases. Due to improved function, enhanced quality of life, and acceptable local recurrence rates, limb salvage surgery has replaced external hemipelvectomies in many cases of primary malignancies. However, large segmental bony defects and poor bone quality due to the disease process itself and subsequent treatment (i.e. chemotherapy and radiation) can make stable implant fixation difficult when performing a total hip arthroplasty (THA) for oncologic periacetabular lesions with concurrent fractures. Various methods are available to reconstruct the hemipelvis, and include large structural allografts, allograft-prosthetic composites (APCs), custom-made endoprostheses, modular saddle prostheses, and modular hemipelvis endoprostheses. However, short- and mid-term results from our institution indicate that tantalum reconstructions with adjuvant screw fixation and supplemental reinforcement cages provide reasonable improvement in clinical outcomes and stable fixation in situations with massive bone loss and compromised bone quality. On the femoral side, cemented fixation remains a viable option (including proximal femoral replacements), but uncemented distal fixation with extensively-porous coated cylindrical stems or modular fluted tapered stems can be considered if the disease process (or subsequent treatment) primarily affects the proximal femur. In addition to long-term fixation, post-operative dislocations remain a significant concern given the often compromised abductor mechanism

The June 2012 Oncology Roundup³⁶⁰ looks at: avoiding pelvic hemipelvectomy; proximal femoral metastasis; extendible prostheses; rotationplasty; soft-tissue sarcomas; osteosarcoma of the pelvis; recurrent chondrosarcoma ; MRI and the differentiation between benign and malignant lesions; and malignant fibrous histiocytoma.