Skip to main content
SpringerLink
Log in

Morbidity and Functional Status of Patients With Pelvic Neurogenic Tumors After Wide Excision

  • Symposium: Highlights of the ISOLS/MSTS 2009 Meeting
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

We previously reported that over the last 10 years our practice has evolved in the treatment of neurogenic tumors of the pelvis to include a multispecialty team of surgeons, a factor that might decrease morbidity and improve recurrence, survival, and function.

Questions/purposes

Therefore, we (1) assessed the morbidity associated with surgical excision in patients with neurogenic tumors of the pelvis; (2) determined the function of these patients; and (3) determined the rates of local recurrence, metastasis, and overall survival with this new approach.

Methods

We reviewed the records of all 38 patients who had surgery for a pelvic plexus tumor between 1994 and 2005. Twenty one were male. The mean age of all patients was 38 years and median follow up was 2.1 years. Twelve patients had a malignant tumor. We recorded demographic data, postoperative complications, tumor-specific recurrence, and determined survival.

Results

Postoperative complications occurred in nine of the 38 patients (23%): hematoma (n = 3), wound infection or deep abscess (n = 3), and deep venous thrombosis (n = 3). Surgical complications occurred more frequently in patients with malignant disease. Patients with benign tumors had a mean MSTS score of 94%, while survivors of malignant disease had a mean of 57%. For malignant tumors, the 5-year rate of local recurrence was 40%, the estimated 5-year rate of metastasis was 67% and 5-year survival rate was 50%.

Conclusion

Using a team approach, surgical excision provided high functional scores for patients with benign disease with a low rate of complications. In patients with malignant tumors, intentional wide resection is associated with higher morbidity but yields acceptable functional scores.

Level of Evidence

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–C

Similar content being viewed by others

References

  1. Abernathey CD, Onofrio BM, Scheithauer B, Pairolero PC, Shives TC. Surgical management of giant sacral schwannomas. J Neurosurg. 1986;65:286–295.

    Article  CAS  PubMed  Google Scholar 

  2. Anghileri M, Miceli R, Fiore M, Mariani L, Ferrari A, Mussi C, Lozza L, Collini P, Olmi P, Casali PG, Pilotti S, Gronchi A. Malignant peripheral nerve sheath tumors: prognostic factors and survival in a series of patients treated at a single institution. Cancer. 2006;107:1065–1074.

    Article  PubMed  Google Scholar 

  3. Baehring JM, Betensky RA, Batchelor TT. Malignant peripheral nerve sheath tumor: the clinical spectrum and outcome of treatment. Neurology. 2003;61:696–698.

    PubMed  Google Scholar 

  4. Cody HS III, Marcove RC, Quan SH. Malignant retrorectal tumors: 28 years’ experience at Memorial Sloan-Kettering Cancer Center. Dis Colon Rectum. 1981;24:501–506.

    Article  PubMed  Google Scholar 

  5. Collin C, Godbold J, Hajdu S, Brennan M. Localized extremity soft tissue sarcoma: an analysis of factors affecting survival. J Clin Oncol. 1987;5:601–612.

    CAS  PubMed  Google Scholar 

  6. Dafford K, Kim D, Reid N, Kline D. Pelvic plexus tumors. Neurosurg Focus. 2007;22:E10.

    PubMed  Google Scholar 

  7. Dozois EJ, Wall JC, Spinner RJ, Jacofsky DJ, Yaszemski MJ, Sim FH, Moran SL, Cima RR, Larson DR, Haddock MG, Okuno SH, Larson DW. Neurogenic tumors of the pelvis: clinicopathologic features and surgical outcomes using a multidisciplinary team. Ann Surg Oncol. 2009;16:1010–1016.

    Article  PubMed  Google Scholar 

  8. Ducatman BS, Scheithauer BW, Piepgras DG, Reiman HM, Ilstrup DM. Malignant peripheral nerve sheath tumors: a clinicopathologic study of 120 cases. Cancer. 1986;57:2006–2021.

    Article  CAS  PubMed  Google Scholar 

  9. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993;286:241–246.

    PubMed  Google Scholar 

  10. Gachiani J, Kim D, Nelson A, Kline D. Surgical management of malignant peripheral nerve sheath tumors. Neurosurg Focus. 2007;22:E13.

    PubMed  Google Scholar 

  11. Ghosh BC, Ghosh L, Huvos AG, Fortner JG. Malignant schwannoma: a clinicopathologic study. Cancer. 1973;31:184–190.

    Article  CAS  PubMed  Google Scholar 

  12. Hruban RH, Shiu MH, Senie RT, Woodruff JM. Malignant peripheral nerve sheath tumors of the buttock and lower extremity: a study of 43 cases. Cancer. 1990;66:1253–1265.

    Article  CAS  PubMed  Google Scholar 

  13. Jao SW, Beart RW Jr, Spencer RJ, Reiman HM, Ilstrup DM. Retrorectal tumors. Mayo Clinic experience, 1960–1979. Dis Colon Rectum. 1985;28:644–652.

    Article  CAS  PubMed  Google Scholar 

  14. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481.

    Article  Google Scholar 

  15. Kar M, Deo SV, Shukla NK, Malik A, DattaGupta S, Mohanti BK, Thulkar S. Malignant peripheral nerve sheath tumors (MPNST): clinicopathological study and treatment outcome of twenty-four cases. World J Surg Oncol. 2006;4:55.

    Article  PubMed  Google Scholar 

  16. Kim DH, Murovic JA, Tiel RL, Kline DG. Operative outcomes of 546 Louisiana State University Health Sciences Center peripheral nerve tumors. Neurosurg Clin N Am. 2004;15:177–192.

    Article  PubMed  Google Scholar 

  17. Lev-Chelouche D, Gutman M, Goldman G, Even-Sapir E, Meller I, Issakov J, Klausner JM, Rabau M. Presacral tumors: a practical classification and treatment of a unique and heterogeneous group of diseases. Surgery. 2003;133:473–478.

    Article  PubMed  Google Scholar 

  18. Ransom HK, Kay EB. Abdominal neoplasms of neurogenic origin. Ann Surg. 1940;112:700–746.

    CAS  PubMed  Google Scholar 

  19. Raut CP, Pisters PW. Retroperitoneal sarcomas: combined-modality treatment approaches. J Surg Oncol. 2006;94:81–87.

    Article  PubMed  Google Scholar 

  20. Thomas JE, Piepgras DG, Scheithauer B, Onofrio BM, Shives TC. Neurogenic tumors of the sciatic nerve: a clinicopathologic study of 35 cases. Mayo Clin Proc. 1983;58:640–647.

    CAS  PubMed  Google Scholar 

  21. Wirbel RJ, Schulte M, Mutschler WE. Surgical treatment of pelvic sarcomas: oncologic and functional outcome. Clin Orthop Relat Res. 2001;390:190–205.

    Article  PubMed  Google Scholar 

  22. Woodruff JM. Pathology of tumors of the peripheral nerve sheath in type 1 neurofibromatosis. Am J Med Genet. 1999;89:23–30.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Bahtiyar Demiralp, MD for helping with data collection, and Patrick D. J. Fitz-Gibbon, BS, and Dirk Larson, MS, for counseling on the statistics analysis.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, 200 First, SW, Rochester, MN, 55905, USA

    Joseph Alderete MD, Peter S. Rose MD & Franklin F. Sim MD

  2. Musculoskeletal Oncology, Mayo Clinic, Rochester, MN, USA

    Eduardo N. Novais MD

  3. Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA

    Eric J. Dozois MD

Authors
  1. Joseph Alderete MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eduardo N. Novais MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eric J. Dozois MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter S. Rose MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Franklin F. Sim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Franklin F. Sim MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

About this article

Cite this article

Alderete, J., Novais, E.N., Dozois, E.J. et al. Morbidity and Functional Status of Patients With Pelvic Neurogenic Tumors After Wide Excision. Clin Orthop Relat Res 468, 2948–2953 (2010). https://doi.org/10.1007/s11999-010-1478-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-010-1478-2

Keywords

Search

Navigation