Kollender Y, Shabat S, Bickels J, Flusser G, Isakov J, Neuman Y, Cohen I, Weyl-Ben-Arush M, Ramo N, Meller I
The National Unit of Orthopedic Oncology, in four different hospitals in Israel, Israel.
Eur J Surg Oncol. 2000 Jun;26(4):398-404. doi: 10.1053/ejso.1999.0906.
Pelvic bone sarcomas in children and young adults are rare, and associated with a poor prognosis and a high rate of local recurrence. Primary goals of treatment include prevention of local recurrence and distant metastases. A secondary goal is maintenance of quality of life by avoiding major amputative surgery. This is why internal hemipelvectomy (a limb-sparing surgery) is advocated whenever possible. The focus of our presentation is surgical issues in the context of resection and reconstruction of the pelvis in the first two decades of life.
Between January 1988 and June 1998, 27 patients were treated and operated on (follow-up time 1.5-12 years). There were 17 males and 10 females. Their age ranged between 2 and 22 years. There were 24 patients with Ewing's sarcoma (ES) and three with other bone sarcomas. In 19 patients the tumour involved the entire or part of the iliac bone (in some cases with extension to the sacrum). In five patients the tumour involved the pubis and/or ischium. In three patients the tumour involved the sacrum with some extension to the posterior iliac bone. All patients received neoadjuvant and adjuvant chemotherapy and radiotherapy with different protocols (related to the origin of referral).
Twenty-seven patients underwent internal hemipelvectomy. According to Enneking's classification there were: type I-10; type II-one; type III-six; type IV-five (including one localized sacrectomy); type I+IV-five patients. In 15 patients some kind of reconstruction was needed and in 12 no reconstruction was done. Four wound infections occurred that were managed successfully by surgical debridement, antibiotics and local wound care. In one case removal of the 'implant' was needed. No primary or secondary amputations were performed in the series. The rate of local recurrence was 22%. Functional status at the last follow-up visit or before death, according to the AMSTS functional rating system: excellent-six; good-17; fair-three and poor-one. All patients except the one poor result maintained their walking ability during the follow-up time.
Internal hemipelvectomy is achievable in most cases and justified for better quality of life in children, adolescents and young adults with sarcomas. Further efforts are needed to improve the reconstructive options in the pelvis.
儿童和青年的骨盆骨肉瘤较为罕见，预后较差且局部复发率高。治疗的主要目标包括预防局部复发和远处转移。次要目标是通过避免大型截肢手术来维持生活质量。这就是为什么只要有可能就提倡进行半骨盆内切除术（一种保肢手术）。我们报告的重点是在生命的前二十年中骨盆切除与重建背景下的手术问题。
1988年1月至1998年6月，对27例患者进行了治疗和手术（随访时间为1.5至12年）。其中男性17例，女性10例。年龄在2至22岁之间。24例为尤因肉瘤（ES），3例为其他骨肉瘤。19例患者的肿瘤累及全部或部分髂骨（某些病例延伸至骶骨）。5例患者的肿瘤累及耻骨和/或坐骨。3例患者的肿瘤累及骶骨并部分延伸至髂骨后部。所有患者均接受了新辅助和辅助化疗以及不同方案的放疗（与转诊来源有关）。
27例患者接受了半骨盆内切除术。根据恩内金分类：I型10例；II型1例；III型6例；IV型5例（包括1例局限性骶骨切除术）；I + IV型5例。15例患者需要某种重建，12例未进行重建。发生了4例伤口感染，通过手术清创、抗生素和局部伤口护理成功处理。1例需要取出“植入物”。该系列中未进行一期或二期截肢。局部复发率为22%。根据AMSTS功能评分系统，最后一次随访或死亡前的功能状态：优秀6例；良好17例；尚可3例；差1例。除1例结果差的患者外，所有患者在随访期间均保持了行走能力。
在大多数情况下，半骨盆内切除术是可行的，对于患有肉瘤的儿童、青少年和青年改善生活质量是合理的。需要进一步努力改善骨盆的重建选择。
