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Internal Hemipelvectomy for Pelvic Sarcomas Using a T-incision Surgical Approach

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Clinical Orthopaedics and Related Research®


Internal hemipelvectomy is performed for pelvic sarcomas when the tumor can be safely resected without sacrificing the entire extremity. Wide exposure and awareness of major neurovascular structures are crucial to the success of this surgery. Various modifications on the standard utilitarian approach have been used to best achieve these goals. We reviewed our experience using the T-incision technique for 30 pelvic sarcoma resections. The minimum followup was 3.6 months (mean, 55 months; range, 3.6–185.4 months). Postoperative complications included minor complications (requiring no surgery or a simple incision and drainage with primary closure) in 27% of patients and major complications (involving a deep infection or more extensive surgical treatment) in 17%. Ninety-two percent of wound complications healed uneventfully with antibiotics and incision and drainage. The 2-, 5-, and 10-year patient survival rates were 67%, 59%, and 53%. The 2-, 5-, and 10-year disease-free survival rates were 68%, 42%, and 42%. The mean Musculoskeletal Tumor Society and Toronto Extremity Salvage Scores were 69% and 86%, respectively. We believe the T-incision technique for internal hemipelvectomy is an effective surgical approach for pelvic sarcomas when limb salvage is possible.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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We thank Stephen Brown from Stryker Orthopaedics for creating the illustration depicted in Figure 1.

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Correspondence to Richard D. Lackman MD.

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One or more of the authors (EAC, JJK) have received funding (research fellowship) from Stryker-Howmedica-Osteonics, Mahwah, NJ. One of the authors (RDL) is a consultant for Stryker-Howmedica-Osteonics, Mahwah, NJ.

Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Pennsylvania Hospital at the University of Pennsylvania.

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Lackman, R.D., Crawford, E.A., Hosalkar, H.S. et al. Internal Hemipelvectomy for Pelvic Sarcomas Using a T-incision Surgical Approach. Clin Orthop Relat Res 467, 2677–2684 (2009).

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