En bloc resection of extra-peritoneal soft tissue neoplasms incorporating a type III internal hemipelvectomy: a novel ap
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REVIEW
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
En bloc resection of extra-peritoneal soft tissue neoplasms incorporating a type III internal hemipelvectomy: a novel approach Sanjay S Reddy1* and Norman D Bloom2
Abstract Background: A type III hemipelvectomy has been utilized for the resection of tumors arising from the superior or inferior pubic rami. Methods: In eight patients, we incorporated a type III internal hemipelvectomy to achieve an en bloc R0 resection for tumors extending through the obturator foramen or into the ischiorectal fossa. The pelvic ring was reconstructed utilizing marlex mesh. This allowed for pelvic stability and abdominal wall reconstruction with obliteration of the obturator space to prevent herniations. Results: All eight patients had an R0 resection with an overall survival of 88% and with average follow up of 9.5 years. Functional evaluation utilizing the Enneking classification system, which evaluates motion, pain, stability and strength of the affected extremity, revealed a 62% excellent result and a 37% good result. No significant complications were associated with the operative procedure. Marlex mesh reconstruction provided pelvic stability and eliminated all hernial defects. Conclusion: The superior and inferior pubic rami provide a barrier to a resection for tumors that arise in the extra-peritoneal pelvis extending through the obturator foramen or ischiorectal fossa. Incorporating a type III internal hemipelvectomy with a simple marlex mesh reconstruction allows for complete tumor resection without functional compromise, acute infectious issues, obturator or abdominal hernia defects.
Introduction A novel approach to the en bloc resection of extraperitoneal soft tissue neoplasms, incorporating a type III internal hemipelvectomy, to achieve clear surgical margins, was performed in eight patients. The use of a type III internal hemipelvectomy in the resection of primary bone tumors has been widely employed. Type III resections, as classified by Enneking and Dunham involves resection of the superior and inferior pubic rami and obturator foramen [1]. The use of type III internal hemipelvectomy for osseous lesions is not common. In two large series of internal hemipelvectomies, type III has been performed in three out of thirty patients (10%) [2], and in four out of fifty-eight patients (7%) [3]. In this series of patients we have extended the indication
for this procedure to soft tissue tumors arising in the extraperitoneal pelvis with extension through the obturator foramen into the adductor group, or into the ischiorectal fossa. This is a rare presentation for these tumors and any standard operative approach for a complete resection would lead to a violation of the tumor, as the central bony pelvis provides a barrier to an en bloc resection. A type III hemipelvectomy is not without its associated complications, which include vascular, bladder and urethral injuries, as well as infections and wound issues related to the groin incision [4]. No reconstruction of the pelvic
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