Pelvic Resections and Reconstruction for Bone Tumours

Abstract

Pelvic resections represent a challenging and difficult part of oncological surgery with a relatively high rate of complications. The author presents his experiences as well as data from the literature. When considering the type of resection as well as reconstruction, meticulous planning of the surgery into individual steps after which the surgery can be interrupted must be made. In major surgeries both anterior and posterior approaches should be prepared. Computer navigated surgery can be helpful for resection cuts especially in the sacro-iliac region. Different types of reconstructions are discussed depending on the type of resection according to the Enneking-Dunham classification. Both biological and artificial reconstructions have their advantages as well as disadvantages. The histological type of tumour also influences the extent of resection as well as reconstruction types. In Ewing sarcoma the procedure should be as simple as possible in order to enable an early onset of oncological treatment within two weeks after surgery. In osteosarcoma and especially chondrosarcoma the resection margins must be adequate and a more sophisticated reconstruction is justified. As no method can be clearly preferred, the individuality as well as social factors and wishes of the patient must be considered and accepted when planning the surgery. The ice-cream coned stemmed cup seems a good preferable method for artificial reconstructions after peri-acetabular resections, but resection-reimplantation methods can also become an alternative in the future.