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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2012

01-12-2012 | Bone and Soft Tissue Sarcomas

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

Authors: Jin Wang, PhD, Qinglian Tang, MD, Xianbiao Xie, PhD, Junqiang Yin, PhD, Zhiqiang Zhao, MD, Zhibin Li, PhD, Changye Zou, PhD, Gang Huang, PhD, Jingnan Shen, PhD

Published in: Annals of Surgical Oncology | Issue 13/2012

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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.
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Metadata
Title
Iliosacral Resections of Pelvic Malignant Tumors and Reconstruction with Nonvascular Bilateral Fibular Autografts
Authors
Jin Wang, PhD
Qinglian Tang, MD
Xianbiao Xie, PhD
Junqiang Yin, PhD
Zhiqiang Zhao, MD
Zhibin Li, PhD
Changye Zou, PhD
Gang Huang, PhD
Jingnan Shen, PhD
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 13/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2339-x

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