Department of Orthopedic Surgery, Inselspital, Bern University Hospital, CH-3010, Bern, Switzerland.
Department of Medical Oncology, Inselspital, Bern University Hospital, CH-3010, Bern, Switzerland.
J Orthop Surg Res. 2019 Jul 23;14(1):232. doi: 10.1186/s13018-019-1275-x.
Pelvic tumors are usually resected through the utilitarian pelvic incision, an extended ilioinguinal/iliofemoral approach. The pararectus approach, an intrapelvic anatomical approach with extraperitoneal access to the pelvis, has been established previously for the treatment of pelvic and acetabular fractures. However, it has not been used to address pelvic tumors. The study aimed at investigating the feasibility of this approach for pelvic tumor surgery and the possibilities of combining this approach with standard approaches to the hip joint.
Thirteen patients that underwent pelvic tumor resections were retrospectively reviewed. Tumor resections were performed through the pararectus (n = 10) or extended pararectus approach (n = 3). In six of those cases, the pararectus approach was combined with extrapelvic approaches including the modified Gibson (n = 4), the Kocher-Langenbeck (n = 1), and the trochanteric flip approach (n = 1). The mean follow-up was 32.6 ± 9.1 months.
In all cases, the tumor resections were carried out according to the preoperative plan. In seven of 13 cases, wide resections were performed; six of 13 cases were planned close resections. Four cases of major complications were observed (vascular injury, deep infection, iliac vein thrombosis, total hip arthroplasty dislocation). Minor complications were observed in two cases. One tumor recurred locally. At the final follow-up, 10 patients were alive, eight of those without evidence of disease.
The study demonstrated the suitability of the pararectus approach for pelvic tumor resections. The possibility to combine the approach with standard approaches to the hip joint allowed for single-stage reconstructions of the pelvis and the hip joint without sacrificing surgical margins and function. The pararectus approach is a versatile option adding to the established approaches for musculoskeletal tumor surgery of the pelvis.
盆腔肿瘤通常通过实用的盆腔切口（改良的髂腹股沟/股血管入路）进行切除。既往已建立腹膜外入路的旁正中入路（pararectus approach），用于治疗骨盆和髋臼骨折，但尚未用于治疗盆腔肿瘤。本研究旨在探讨该入路用于盆腔肿瘤手术的可行性，以及将该入路与髋关节标准入路相结合的可能性。
回顾性分析 13 例接受盆腔肿瘤切除术的患者。肿瘤切除术通过旁正中（n=10）或改良旁正中入路（n=3）进行。其中 6 例病例采用旁正中入路联合骨盆外入路，包括改良 Gibson 入路（n=4）、Kocher-Langenbeck 入路（n=1）和转子间翻转入路（n=1）。平均随访时间为 32.6±9.1 个月。
所有病例均按术前计划完成肿瘤切除。13 例中有 7 例为广泛切除，13 例中有 6 例为切缘接近肿瘤的切除。4 例发生重大并发症（血管损伤、深部感染、髂静脉血栓形成、全髋关节置换脱位），2 例发生轻微并发症。1 例肿瘤局部复发。末次随访时，10 例患者存活，其中 8 例无疾病证据。
本研究表明旁正中入路适用于盆腔肿瘤切除术。该入路与髋关节标准入路相结合的可能性允许在不牺牲手术切缘和功能的情况下对骨盆和髋关节进行一期重建。旁正中入路是一种多用途的选择，增加了骨盆肌肉骨骼肿瘤手术的既定入路。
