Advertisement

Orthopedic Surgery and Femoral/Humeral Fracture Repairs

Anesthesia for Hemipelvectomy and Sacrectomy Procedures
  • Matthew John ByarsEmail author
  • Javier D. Lasala
Reference work entry

Abstract

Hemipelvectomy and sacrectomy are considered long and potentially dangerous orthopedic procedures used for the treatment of soft tissue and bony tumors of the pelvis. The danger is mainly due to the expected significant blood loss during tumor and bone resection. Hemipelvectomies are classed as internal or external, and both share large potential for overall loss of blood. Internal concerns bone resection of the ilium, the periacetabulum, or the pubis. External includes bone resection in the pelvis plus amputation of the affected femur (a high level of amputation). Sacrectomy involves partial or en bloc removal of the sacrum with dissection and ligation of the included neurovascular bundles. It may be included with a hemipelvectomy due to structures affected by the tumor(s). Also included in these cases may be complete or partial removal of organs and viscera such as the bladder, ureters, rectum, perineum, prostate, small or large bowel, vagina, cervix, and uterus. In order to assist with closing the wound left from the sacrectomy, an anterior or posterior rotational skin flap may be utilized (usually anterior).

Soft tissue sarcomas and bone tumors are the primary cancer etiologies requiring these surgeries. Generally, patients will have completed other types of treatment including chemotherapy or radiation prior to a surgeon considering this uncommon and radical procedure. Proper preparation by the anesthesia and surgical teams can reduce hemodynamic instability and provide for adequate analgesia and make the patient’s recovery more successful. Proper anesthetic preparation for these cases is paramount, as the hemodynamic instability due to blood loss is the largest risk to the patient both intraoperatively and postoperatively.

Keywords

Hemipelvectomy Sacrectomy Pelvic sarcomas Hemipelvectomy anesthesia Sacrectomy anesthesia Amputation 

References

  1. 1.
    American Society of Anesthesiologists. Massive Transfusion Protocol (MTP) for hemorrhagic shock. (n.d.). http://www.asahq.org/.../MTPforASATransfusionCommitteeFinal/en/1. Accessed 14 Aug 2016.Google Scholar
  2. 2.
    Apffelstaedt JP, Zhang PJ, Driscoll DL, et al. Various types of hemipelvectomy for soft tissue sarcomas: complications, survival and prognostic factors. Surg Oncol. 1995;4(4):217–22.CrossRefGoogle Scholar
  3. 3.
    Baliski CR, Schachar NS, McKinnon JG, et al. Hemipelvectomy: a changing perspective for a rare procedure. Can J Surg. 2004;47(2):99–103.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Beck LA, Einertson MJ, Winemiller MH, et al. Functional outcomes and quality of life after tumor-related hemipelvectomy. Phys Ther. 2008;88(8):916–27.CrossRefGoogle Scholar
  5. 5.
    Biermann JS, Adkins D, Benjamin R, et al. Bone cancer: clinical practice guidelines in oncology™. J Natl Compr Cancer Netw. 2007;5(4):420–37.CrossRefGoogle Scholar
  6. 6.
    Chao AH, Neimanis SA, Chang DW, et al. Reconstruction after internal hemipelvectomy. Ann Plast Surg. 2015;74(3):342–9.  https://doi.org/10.1097/sap.0b013e31829778e1.CrossRefPubMedGoogle Scholar
  7. 7.
    Couto AG, Araujo B, Torres de Vasconcelos RA, et al. Survival rate and perioperative date of patients who have undergone hemipelvectomy: a retrospective case series. World J Surg Oncol. 2016;14(255):1–7.  https://doi.org/10.1186/s12957-016-1001-7.CrossRefGoogle Scholar
  8. 8.
    Elrod CS. Acute care handbook for physical therapists. 4th ed. 2014.  https://doi.org/10.1016/C2011-0-05707-1.
  9. 9.
    Freeman AK, Thorne CJ, Gaston CL, et al. Hypotensive epidural anesthesia reduces blood loss in pelvic and sacral bone tumor resections. Clin Orthop Relat Res. 2016;475(3):634–40.CrossRefGoogle Scholar
  10. 10.
    Ham JS, Koops HS, Veth RPH, et al. External and internal hemipelvectomy for sarcomas of the pelvic girdle: consequences of limb-salvage treatment. Eur J Surg Oncol. 1997;23(6):540–6.CrossRefGoogle Scholar
  11. 11.
    Hendrickson JE, Hillyer CD. Noninfectious serious hazards of transfusion. Anesth Analg. 2009;108(3):759–69.  https://doi.org/10.1213/ane.0b013e3181930a6e.CrossRefPubMedGoogle Scholar
  12. 12.
    Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma. JAMA. 2015;313(5):471.  https://doi.org/10.1001/jama.2015.12.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Kulkarni A, Gupta A. A retrospective analysis of massive blood transfusion and post-operative complications in patients undergoing supra-major orthopaedic oncosurgeries. Indian J Anaesth. 2016;60(4):270.  https://doi.org/10.4103/0019-5049.179465.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Lietman SA, Higuera C. Case presentation. Cleveland Clinic, Orthopaedic Insights. November 9, 2015.Google Scholar
  15. 15.
    Mavrogenis AF, Soultanis K, Patapis P, et al. Pelvic resections. Orthopedics. 2012;35(2):232–41.Google Scholar
  16. 16.
    Mcdaniel LM, Etchill EW, Raval JS, et al. State of the art: massive transfusion. Transfus Med. 2014;24(3):138–44.  https://doi.org/10.1111/tme.12125.CrossRefPubMedGoogle Scholar
  17. 17.
    Mcgrath C. Blood transfusion strategies for hemostatic resuscitation in massive trauma. Nurs Clin N Am. 2016;51(1):83–93.  https://doi.org/10.1016/j.cnur.2015.11.001.CrossRefGoogle Scholar
  18. 18.
    Melnyk M, Casey RG, Koupparis AJ. Enhanced recovery after surgery (ERAS) protocols: time to change practice? J Can Urol Assoc. 2011;5(5):342–8.  https://doi.org/10.5489/cuaj.11002.CrossRefGoogle Scholar
  19. 19.
    Molnar R, Emery G, Choong P. Anaesthesia for hemipelvectomy-a series of 49 cases. Anaesth Intensive Care. 2007;35(4):536–43.CrossRefGoogle Scholar
  20. 20.
    Myers P. Anesthesia for hemipelvectomy and sacrectomy protocol. University of Texas MD Anderson Cancer Center; 2015.Google Scholar
  21. 21.
    Pring ME, Weber KL, Unni KK, et al. Chondrosarcoma of the pelvis: a review of sixty-four cases. J Bone Joint Surg. 2001;83(11):1630–42.CrossRefGoogle Scholar
  22. 22.
    Shoa QD, Yan X, Sun JY, et al. Internal hemipelvectomy with reconstruction for primary pelvic neoplasm: a systematic review. ANZ J Surg. 2015;85(7–8):553–60.  https://doi.org/10.1111/ans.12895.CrossRefGoogle Scholar
  23. 23.
    Sihler KC, Napolitano LM. Complications of massive transfusion. Chest. 2010;137(1):209–20.  https://doi.org/10.1378/chest.09-0252.CrossRefPubMedGoogle Scholar
  24. 24.
    Umer M, Ali M, Rashid RH et al. Blood bank bleeding emergency protocol. University of Texas MD Anderson Cancer Center; 2015.Google Scholar
  25. 25.
    Umer M, Ali M, Rashid RH, et al. Outcomes of internal hemipelvectomy for pelvic tumors: a developing country’s perspective. Int J Surg Oncol. 2017;2(4):e07.  https://doi.org/10.1097/IJ9.0000000000000007.CrossRefGoogle Scholar
  26. 26.
    Wedemeyer C, Kauther MD. Hemipelvectomy- only a salvage therapy? Orthop Rev. 2011;3(1):e4.  https://doi.org/10.4081/or.2011.e4.CrossRefGoogle Scholar
  27. 27.
    Wurtz DL, Peabody TD, Simon MA. Delay in diagnosis and treatment of primary bone sarcoma of the pelvis. J Bone Joint Surg. 1999;81(3):317–25.CrossRefGoogle Scholar
  28. 28.
    Zhang H, Thongtrangan I, Balabhadra RS, et al. Surgical techniques for total sacrectomy and spinopelvic reconstruction. Neurosurg Focus. 2003;15(2):1–10.  https://doi.org/10.3171/foc.2003.15.2.5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Anesthesiology, Critical Care and Pain MedicineUTMD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Anesthesiology and Perioperative MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

Section editors and affiliations

  • Garry Brydges
    • 1
  1. 1.Department of Anesthesiology Division of Anesthesia, Critical Care and Pain MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations