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

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Acknowledgment

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

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Authors and Affiliations

  1. Muskulaskeletal Oncology Department, Department of Orthopaedic Oncology, First Affiliated Hospital of Zhongshan University, Guangzhou, Guangdong, China

    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

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  1. Jin Wang PhD
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  2. Qinglian Tang MD
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  4. Junqiang Yin PhD
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Correspondence to Jingnan Shen PhD.

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Jin Wang and Qinglian Tang contributed equally to this work.

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Wang, J., Tang, Q., Xie, X. et al. Iliosacral Resections of Pelvic Malignant Tumors and Reconstruction with Nonvascular Bilateral Fibular Autografts. Ann Surg Oncol 19, 4043–4051 (2012). https://doi.org/10.1245/s10434-012-2339-x

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  • DOI: https://doi.org/10.1245/s10434-012-2339-x

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