Page 35 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Introduction
Chondrosarcomas are among the most frequent primary tumors of bone. They
represent a heterogeneous group of lesions, of which the conventional primary 2 central subtype is the most common (~75-80%)1-3. Conventional chondrosarcomas
are histologically classi ed into grades 1 to 3. Chondrosarcoma is relatively
resistant to radiation and chemotherapy, and a surgical procedure therefore
remains the mainstay of treatment1-3. Although curettage with local adjuvants is
generally considered a good treatment option for low-grade chondrosarcoma
of long bones, most authors recommend resection with clear margins for pelvic chondrosarcoma of any grade1, 4-8.
Traditionally, pelvic bone tumors were treated with hindquarter amputation (also known as external hemipelvectomy), a procedure associated with unfavorable functional and cosmetic outcomes9-12. Nowadays, most pelvic neoplasms are treated with a limb-salvaging en bloc resection13, 14. These internal hemipelvectomies are some of the most challenging procedures in orthopaedic oncology because of the complex pelvic anatomy, the proximity of major neurovascular structures, the fact that pelvic tumors are often large by the time of diagnosis, and challenges associated with reconstruction13-17. As a result, pelvic tumors resections are associated with a substantial risk of contaminated margins18.
Previous studies on pelvic chondrosarcoma combined di erent subtypes, although central chondrosarcomas are more often high-grade and appear to have a worse prognosis than secondary peripheral lesions4, 16, 19-22. The aim of this multicenter study was to assess disease-speci c and progression-free survival, risk factors for impaired survival, and complications after a surgical procedure in patients treated for a conventional primary central chondrosarcoma of pelvic bone.
Patients and Methods
A total of 170 patients who underwent surgery for a conventional (grades 1 to 3) primary central chondrosarcoma of the pelvis from 1985 to 2013 were identi ed through our institutional tumor databases. Eight patients (5%) underwent curettage: four grade 1 intracompartmental tumors (all continuously no evidence of disease at the time of follow-up), one grade 1 tumor with a higher-grade
Pelvic chondrosarcoma
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