It is a procedure that involves removing a tumor (usually malignant or benign aggressive) of the pelvis while preserving the lower limbs and surrounding tissues.
The pelvis is a common site for malignant and benign tumors to arise. The pelvis is composed of three parts; the ischium, illium, and pubis. The socket (hip joint) is called the acetabulum which forms the “cup.” Common primary sarcomas that can arise from the pelvis include osteosarcoma, Ewing’s Sarcoma, and chondrosarcoma. Soft tissue malignant tumors can sometimes involve the pelvis as well. Additionally, metastatic disease can commonly spread to the pelvis. Limb-sparing surgery can be performed for approximately 95% of tumors arising from the pelvis. In some instances the extremity cannot be saved and an amputation is performed.
Contraindications for saving the limb may include neurovascular invasion, infection, pathological fracture, extensive disease, contamination from a poorly performed biopsy, recurrent disease.
An incision is made that curves across the top of the femur bone.
Developing surgical planes (margins that are tumor free) and separating muscles that can be preserved and leaving those in continuity with the tumor that should be removed, such as the gluteus muscles and iliac. This is based on preoperative MRI and intraoperative findings as well as the type of tumor.
The sciatic nerve is identified and preserved as well as the femoral nerve. The nerves and blood vessels associated with the tumor or embedded in the tumor are ligated (closed off) and removed.
Removal of tumor and reconstruction. Once the tumor is removed the bone and joint are restored (reconstructed) if the tumor involved the “ball and socket” region. A “cup” may be utilized to replace the acetabulum if it was removed during surgery.
To reconstruct the hip after the tumor is removed, the gluteus medius muscle is attached to the abdomen as well as the adductors muscle. The sutures may be reinforced with surgical tape.
We then close your incision with sutures and cover the surgical site with bandages. Multiple large drains may also be used to drain the surgical site and prevent a seroma (buildup of fluid).
After your surgery you will be recuperating at home. For the first few days you will ice the area and keep it elevated to reduce swelling. You will return to the office 2 weeks after surgery. Depending on what is done during surgery you may be non-weight bearing for a period of time. Once cleared, you will subsequently start physical therapy. We usually prescribe physical therapy 3 times a week for 12 weeks after surgery.
You will be monitored periodically with X-rays over the course of 5 years. Sometimes an MRI and/or CT may be used to additionally monitor the area to make sure the tumor has not come back. You will then have follow up appointments every 4 months for the first 2 years, then every 6 months for the next 2 years, and then once a year. Since the bone integrity has been restored to full or almost full, recovery is anticipated provided the patient adheres to strict physical therapy.
Dr. James Wittig narrates a video illustrating the surgical technique for resection of a sacrococcygeal chordoma, using cryosurgery as an adjuvant therapy. | WATCH VIDEO