Pelvic limb-salvage surgery for malignant tumors: 30 years of progress in China_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 GUO Wei ^1,2

1. Department of Orthopaedic Oncology, Peking University, People’s Hospital, Beijing, 100044, P. R. China;
2. Sarcoma and Rare Tumor Center, Peking University, People’s Hospital, Beijing, 100044, P. R. China;

Corresponding author：

GUO Wei, Email: bonetumor@163.com

Keywords：

Pelvic malignant tumors; functional reconstruction; surgical classification; limb-salvage surgery

DOI：

10.7507/1002-1892.202112059

Video：

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This article reviews the development and progress in the field of limb salvage treatment, surgical techniques, and function reconstruction of pelvic malignant tumors in China in the past 30 years. Based on the surgical classification of pelvic tumor resection in different parts, the development of surgical techniques and bone defect repair and reconstruction methods were described in detail. In recent years, in view of the worldwide problem of biological reconstruction after pelvic tumor resection, Chinese researchers have systematically proposed the repair and reconstruction methods and prosthesis design for bone defects after resection of different parts for the first time in the world. In addition, a systematic surgical classification (Beijing classification) was first proposed for the difficult situation of pelvic tumors involving the sacrum, as well as the corresponding surgical plan and repair and reconstruction methods. Through unremitting efforts, the limb salvage rate of pelvic malignant tumors in China has reached more than 80%, which has preserved limbs and restored walking function for the majority of patients, greatly reduced surgical complications, and achieved internationally remarkable results.

Citation： GUO Wei. Pelvic limb-salvage surgery for malignant tumors: 30 years of progress in China. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(7): 781-789. doi: 10.7507/1002-1892.202112059 Copy

1.	Campanacci M, Capanna R. Pelvic resections: the rizzoli institute experience Orthop Clin North Am, 1991, 22(1): 65-86.
2.	Enneking WF, Dunham WK. Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg (Am), 1978, 60(6): 731-746.
3.	Steel HH. Partial or complete resection of the hemipelvis. An alternative to hindquarter amputation for periacetabular chondrosarcoma of the pelvis. J Bone Joint Surg (Am), 1978, 60(6): 719-730.
4.	Guo W, Sun X, Ji T, et al. Outcome of surgical treatment of pelvic osteosarcoma. J Surg Oncol, 2012, 106(4): 406-410.
5.	Aboulafia AJ, Buch R, Mathews J, et al. Reconstruction using the saddle prosthesis following excision of primary and metastatic periacetabular tumors. Clin Orthop Relat Res, 1995, (314): 203-213.
6.	Kitagawa Y, Ek ET, Choong PF. Pelvic reconstruction using saddle prosthesis following limb salvage operation for periacetabular tumour. J Orthop Surg (Hong Kong), 2006, 14(2): 155-162.
7.	Renard AJ, Veth RP, Schreuder HW, et al. The saddle prosthesis in pelvic primary and secondary musculoskeletal tumors: functional results at several postoperative intervals. Arch Orthop Trauma Surg, 2000, 120(3-4): 188-194.
8.	Windhager R, Karner J, Kutschera HP, et al. Limb salvage in periacetabular sarcomas: review of 21 consecutive cases. Clin Orthop Relat Res, 1996, (331): 265-276.
9.	Müller PE, Dürr HR, Wegener B, et al. Internal hemipelvectomy and reconstruction with a megaprosthesis. Int Orthop, 2002, 26(2): 76-79.
10.	Ozaki T, Hoffmann C, Hillmann A, et al. Implantation of hemipelvic prosthesis after resection of sarcoma. Clin Orthop Relat Res, 2002, (396): 197-205.
11.	Fisher NE, Patton JT, Grimer RJ, et al. Ice-cream cone reconstruction of the pelvis: a new type of pelvic replacement: early results. J Bone Joint Surg (Br), 2011, 93(5): 684-688.
12.	Bus MP, Boerhout EJ, Bramer JA, et al. Clinical outcome of pedestal cup endoprosthetic reconstruction after resection of a peri-acetabular tumour. Bone Joint J, 2014, 96-B(12): 1706-1712.
13.	Witte D, Bernd L, Bruns J, et al. Limb-salvage reconstruction with MUTARS hemipelvic endoprosthesis: a prospective multicenter study. Eur J Surg Oncol, 2009, 35(12): 1318-1325.
14.	Bus MP, Szafranski A, Sellevold S, et al. LUMiC^® endoprosthetic reconstruction after periacetabular tumor resection: Short-term results. Clin Orthop Relat Res, 2017, 475(3): 686-695.
15.	Xu J, Xie L, Guo W. Neoadjuvant chemotherapy followed by delayed surgery: Is it necessary for all patients with nonmetastatic high-grade pelvic osteosarcoma? Clin Orthop Relat Res, 2018, 476(11): 2177-2186.
16.	Guo W, Li D, Tang X, et al. Reconstruction with modular hemipelvic prostheses for periacetabular tumor. Clin Orthop Relat Res, 2007, 461: 180-188.
17.	Ji T, Guo W, Yang RL, et al. Modular hemipelvic endoprosthesis reconstruction-experience in 100 patients with mid-term follow-up results. Eur J Surg Oncol, 2013, 39(1): 53-60.
18.	Liang H, Ji T, Zhang Y, et al. Reconstruction with 3D-printed pelvic endoprostheses after resection of a pelvic tumour. Bone Joint J, 2017, 99-B(2): 267-275.
19.	Ji T, Yang Y, Tang X, et al. 3D-Printed modular hemipelvic endoprosthetic reconstruction following periacetabular tumor resection: Early results of 80 consecutive cases. J Bone Joint Surg (Am), 2020, 102(17): 1530-1541.
20.	Wang J, Min L, Lu M, et al. Three-dimensional-printed custom-made hemipelvic endoprosthesis for primary malignancies involving acetabulum: the design solution and surgical techniques. J Orthop Surg Res, 2019, 14(1): 389. doi: 10.1186/s13018-019-1455-8.
21.	Wong KC, Kumta SM, Geel NV, et al. One-step reconstruction with a 3D-printed, biomechanically evaluated custom implant after complex pelvic tumor resection. Comput Aided Surg, 2015, 20(1): 14-23.
22.	Zang J, Guo W, Yang Y, et al. Reconstruction of the hemipelvis with a modular prosthesis after resection of a primary malignant peri-acetabular tumour involving the sacroiliac joint. Bone Joint J, 2014, 96-B(3): 399-405.
23.	Zhang Y, Tang X, Ji T, et al. Is a modular pedicle-hemipelvic endoprosthesis durable at short term in patients undergoing enneking type Ⅰ+Ⅱ tumor resections with or without sacroiliac involvement? Clin Orthop Relat Res, 2018, 476(9): 1751-1761.
24.	丁易, 牛晓辉, 刘巍峰, 等. 酒精灭活再植术在骨肿瘤治疗中的应用. 中华骨科杂志, 2011, 31(6): 652-657.
25.	Qu H, Guo W, Yang R, et al. Reconstruction of segmental bone defect of long bones after tumor resection by devitalized tumor-bearing bone. World J Surg Oncol, 2015, 13: 282. doi: 10.1186/s12957-015-0694-3.
26.	范宏斌, 王臻, 郭征, 等. 经 “Y” 型软骨截骨髋臼挽救术治疗儿童和青少年TypeⅡ型骨盆尤文肉瘤. 中华骨科杂志, 2014, 34(4): 460-465.
27.	Zhu D, Fu J, Wang L, et al. Reconstruction with customized, 3D-printed prosthesis after resection of periacetabular Ewing’s sarcoma in children using “triradiate cartilage-based” surgical strategy: a technical note. J Orthop Translat, 2021, 28: 108-117.
28.	Zhang Y, Guo W, Tang X, et al. En bloc resection of pelvic sarcomas with sacral invasion: a classification of surgical approaches and outcomes. Bone Joint J, 2018, 100-B(6): 798-805.
29.	Tang X, Guo W, Yang R, et al. Evaluation of blood loss during limb salvage surgery for pelvic tumours. Int Orthop, 2009, 33(3): 751-756.
30.	Tang X, Guo W, Yang R, et al. Use of aortic balloon occlusion to decrease blood loss during sacral tumor resection. J Bone Joint Surg (Am), 2010, 92(8): 1747-1753.

1. Campanacci M, Capanna R. Pelvic resections: the rizzoli institute experience Orthop Clin North Am, 1991, 22(1): 65-86.
2. Enneking WF, Dunham WK. Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg (Am), 1978, 60(6): 731-746.
3. Steel HH. Partial or complete resection of the hemipelvis. An alternative to hindquarter amputation for periacetabular chondrosarcoma of the pelvis. J Bone Joint Surg (Am), 1978, 60(6): 719-730.
4. Guo W, Sun X, Ji T, et al. Outcome of surgical treatment of pelvic osteosarcoma. J Surg Oncol, 2012, 106(4): 406-410.
5. Aboulafia AJ, Buch R, Mathews J, et al. Reconstruction using the saddle prosthesis following excision of primary and metastatic periacetabular tumors. Clin Orthop Relat Res, 1995, (314): 203-213.
6. Kitagawa Y, Ek ET, Choong PF. Pelvic reconstruction using saddle prosthesis following limb salvage operation for periacetabular tumour. J Orthop Surg (Hong Kong), 2006, 14(2): 155-162.
7. Renard AJ, Veth RP, Schreuder HW, et al. The saddle prosthesis in pelvic primary and secondary musculoskeletal tumors: functional results at several postoperative intervals. Arch Orthop Trauma Surg, 2000, 120(3-4): 188-194.
8. Windhager R, Karner J, Kutschera HP, et al. Limb salvage in periacetabular sarcomas: review of 21 consecutive cases. Clin Orthop Relat Res, 1996, (331): 265-276.
9. Müller PE, Dürr HR, Wegener B, et al. Internal hemipelvectomy and reconstruction with a megaprosthesis. Int Orthop, 2002, 26(2): 76-79.
10. Ozaki T, Hoffmann C, Hillmann A, et al. Implantation of hemipelvic prosthesis after resection of sarcoma. Clin Orthop Relat Res, 2002, (396): 197-205.
11. Fisher NE, Patton JT, Grimer RJ, et al. Ice-cream cone reconstruction of the pelvis: a new type of pelvic replacement: early results. J Bone Joint Surg (Br), 2011, 93(5): 684-688.
12. Bus MP, Boerhout EJ, Bramer JA, et al. Clinical outcome of pedestal cup endoprosthetic reconstruction after resection of a peri-acetabular tumour. Bone Joint J, 2014, 96-B(12): 1706-1712.
13. Witte D, Bernd L, Bruns J, et al. Limb-salvage reconstruction with MUTARS hemipelvic endoprosthesis: a prospective multicenter study. Eur J Surg Oncol, 2009, 35(12): 1318-1325.
14. Bus MP, Szafranski A, Sellevold S, et al. LUMiC^® endoprosthetic reconstruction after periacetabular tumor resection: Short-term results. Clin Orthop Relat Res, 2017, 475(3): 686-695.
15. Xu J, Xie L, Guo W. Neoadjuvant chemotherapy followed by delayed surgery: Is it necessary for all patients with nonmetastatic high-grade pelvic osteosarcoma? Clin Orthop Relat Res, 2018, 476(11): 2177-2186.
16. Guo W, Li D, Tang X, et al. Reconstruction with modular hemipelvic prostheses for periacetabular tumor. Clin Orthop Relat Res, 2007, 461: 180-188.
17. Ji T, Guo W, Yang RL, et al. Modular hemipelvic endoprosthesis reconstruction-experience in 100 patients with mid-term follow-up results. Eur J Surg Oncol, 2013, 39(1): 53-60.
18. Liang H, Ji T, Zhang Y, et al. Reconstruction with 3D-printed pelvic endoprostheses after resection of a pelvic tumour. Bone Joint J, 2017, 99-B(2): 267-275.
19. Ji T, Yang Y, Tang X, et al. 3D-Printed modular hemipelvic endoprosthetic reconstruction following periacetabular tumor resection: Early results of 80 consecutive cases. J Bone Joint Surg (Am), 2020, 102(17): 1530-1541.
20. Wang J, Min L, Lu M, et al. Three-dimensional-printed custom-made hemipelvic endoprosthesis for primary malignancies involving acetabulum: the design solution and surgical techniques. J Orthop Surg Res, 2019, 14(1): 389. doi: 10.1186/s13018-019-1455-8.
21. Wong KC, Kumta SM, Geel NV, et al. One-step reconstruction with a 3D-printed, biomechanically evaluated custom implant after complex pelvic tumor resection. Comput Aided Surg, 2015, 20(1): 14-23.
22. Zang J, Guo W, Yang Y, et al. Reconstruction of the hemipelvis with a modular prosthesis after resection of a primary malignant peri-acetabular tumour involving the sacroiliac joint. Bone Joint J, 2014, 96-B(3): 399-405.
23. Zhang Y, Tang X, Ji T, et al. Is a modular pedicle-hemipelvic endoprosthesis durable at short term in patients undergoing enneking type Ⅰ+Ⅱ tumor resections with or without sacroiliac involvement? Clin Orthop Relat Res, 2018, 476(9): 1751-1761.
24. 丁易, 牛晓辉, 刘巍峰, 等. 酒精灭活再植术在骨肿瘤治疗中的应用. 中华骨科杂志, 2011, 31(6): 652-657.
25. Qu H, Guo W, Yang R, et al. Reconstruction of segmental bone defect of long bones after tumor resection by devitalized tumor-bearing bone. World J Surg Oncol, 2015, 13: 282. doi: 10.1186/s12957-015-0694-3.
26. 范宏斌, 王臻, 郭征, 等. 经 “Y” 型软骨截骨髋臼挽救术治疗儿童和青少年TypeⅡ型骨盆尤文肉瘤. 中华骨科杂志, 2014, 34(4): 460-465.
27. Zhu D, Fu J, Wang L, et al. Reconstruction with customized, 3D-printed prosthesis after resection of periacetabular Ewing’s sarcoma in children using “triradiate cartilage-based” surgical strategy: a technical note. J Orthop Translat, 2021, 28: 108-117.
28. Zhang Y, Guo W, Tang X, et al. En bloc resection of pelvic sarcomas with sacral invasion: a classification of surgical approaches and outcomes. Bone Joint J, 2018, 100-B(6): 798-805.
29. Tang X, Guo W, Yang R, et al. Evaluation of blood loss during limb salvage surgery for pelvic tumours. Int Orthop, 2009, 33(3): 751-756.
30. Tang X, Guo W, Yang R, et al. Use of aortic balloon occlusion to decrease blood loss during sacral tumor resection. J Bone Joint Surg (Am), 2010, 92(8): 1747-1753.

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