External and internal hemipelvectomy for sarcomas of the pelvic girdle: consequences of limb-salvage treatment.
The outcome of different limb-saving treatment modalities for pelvic girdle sarcoma is controversial. The oncological and functional results after 11 external and 10 internal hemipelvectomies and the consequences of limb-salvage treatment were studied in 21 consecutive patients with primary bone (19 patients) or soft tissue sarcoma (two patients) of the pelvic girdle. Following external hemipelvectomy, 10 patients (91%) died after a median follow-up of 1.6 years (range: 0.3-7.1). Isolated local recurrences occurred in three patients (27%), with concomitant distant failure in one (9%), while isolated distant failure occurred in six patients (55%). The rate of flap necrosis and wound infection following external hemipelvectomy were both 25%. Following internal hemipelvectomy, nine patients (90%) were alive without evidence of disease after a median follow-up of 6.6 years (range: 2.3-16.0). Concomitant local and distant failures were found in one patient (10%). Reconstruction-related complications necessitated revisional procedures in five of seven patients (72%), leading to external hemipelvectomy in one. Patients with a locally advanced pelvic girdle sarcoma who are unable to undergo an internal hemipelvectomy have a worse prognosis than patients who undergo an internal hemipelvectomy. An internal hemipelvectomy is not attended by an increased risk of local failure, but is by long-term local complications, requiring extensive surgical procedures.
Ham
S J
SJ
Department of Surgical Oncology, Groningen University Hospital, The Netherlands.
Schraffordt Koops
H
H
Veth
R P
RP
van Horn
J R
JR
Eisma
W H
WH
Hoekstra
H J
HJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006428:Hemipelvectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000601:surgery*; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome