External and internal hemipelvectomy: A retrospective analysis of 68 cases
Mustafa Onur Karaca
, Emre Anıl Özbek, Mustafa Özyıldıran, Abdullah Merter, Kerem Başarır, Hüseyin Yusuf Yıldız, Yener Sağlık
Department of Orthopedics and Traumatology, Ankara University Faculty of Medicine, Ankara, Turkey
Keywords: External hemipelvectomy, hemipelvectomy, internal hemipelvectomy, mortality, pelvic tumors, postoperative infection.
Abstract
Objectives: This study aims to investigate the factors that may be associated with surgical site infection and mortality in pelvic resection surgeries.
Patients and methods: A total of 68 patients (40 males, 28 females; mean age: 43±16.2 years; range, 11 to 70 years) who underwent internal or external hemipelvectomy between January 2010 and January 2020 were retrospectively analyzed. We reviewed data concerning histopathological diagnosis, surgical technique, pelvic resection type, tumor size, postoperative infection, duration of follow-up, and mortality.
Results: The mean follow-up was 45.5±42.2 months. Among 68 patients, 29 (42.6%) cases underwent external hemipelvectomy and 39 (57.4%) cases underwent internal hemipelvectomy. Reconstruction was performed in 14 (20.6%) patients who underwent internal hemipelvectomy. Of all patients, 61 had primary malignant pelvic tumors and two had metastatic pelvic tumors. Of the other five patients, two had a giant cell tumor, two had a pelvic hydatid cyst, and one had an aneurysmal bone cyst. The three most common pelvic tumors were chondrosarcoma (n=25, 36.7%), osteosarcoma (n=13, 19.1%), and Ewing sarcoma (n=8, 11.8%). Surgical site infections were observed in 34 (50.0%) patients. Of 34 patients, 15 (22.1%) had superficial infections and 19 (27.9%) had deep surgical infections. The superficial and deep infection rates were higher in the external hemipelvectomy group compared to internal hemipelvectomy (p=0.02). Patients with postoperative infection had a mean survival period of 36.0 months compared to 79.8 months in patients without infection (p=0.037). The patients treated with internal hemipelvectomy had a mean survival of 97.0 months compared to 25.7 months in patients treated with external hemipelvectomy (p<0.0001). The effect of Enneking stages of malignant pelvic tumors on survival was investigated using the Kaplan-Meier analysis. Cumulative survival decreased, as the stage progressed (p<0.0001).
Conclusion: The type of surgical technique affects the possibility of postoperative infection. Postoperative infection, surgical method, and stage of the tumor are associated with survival.
Citation: Karaca MO, Özbek EA, Özyıldıran M, Merter A, Başarır K, Yıldız HY, Sağlık Y. External and internal hemipelvectomy: A retrospective analysis of 68 cases. Jt Dis Relat Surg 2022;33(1):132- 141.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.