Page 43 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Measured from the diagnosis of local recurrence, median disease-speci c survival
was 2.4 years (95% CI, 1.4 to 3.4 years) for patients with a grade 2 tumor, and 1.3
years (95% CI, 0.9 to 1.7 years) for patients with a grade 3 lesion ( gure 5). Of 62
patients with local recurrence, 30 (48%) developed metastases, compared with 18 2 of 100 (18%) patients without local recurrence (OR 4.27, 95% CI 2.09 to 8.71, p <
0.001).
In our multivariable Cox proportional hazards model, we found that higher
tumor grade, poorer resection margins, larger tumor size, and soft-tissue in ltration signi cantly impaired disease-speci c and progression-free survival (table 4). Patient sex did not signi cantly in uence survival. The risk of intralesional margins was lower for patients with a with a maximal tumor diameter of less than 10 cm (6 of 58 [10%]) than for those with a maximal tumor diameter of 10 cm or more (28 of 93 [30%]) (p = 0.005). Although the risk of contaminated margins was higher after internal hemipelvectomy (35 of 135 [26%]) than after hindquarter amputation (2 of 27 [7%]), hemipelvectomy type did not signi cantly in uence outcome.
Complications after surgery
Ninety- ve patients (59%) required further operations. The main indications for reoperations were deep infection (n=31 [19%]), wound problems (n=20 [12%]), reconstruction-related complications (n=29 [17%]) and reoperations for local recurrences (n=40, 25%). There was no signi cant di erence in infection rates between internal hemipelvectomies (27 of 135 [20%]) and hindquarter amputations (4 of 27 [15%]) (p = 0.532). Infection was more common in patients with an endoprosthetic reconstruction (18 of 60 [30%]), compared with patients with other types of reconstruction (8 of 45 [18%]) or no reconstruction at all (5 of 57 [9%]) (p = 0.014).
Thirteen patients (8%) underwent secondary hindquarter amputation: 10 (6%) for locally residual or recurrent tumors, and three (2%) for infection. One patient (1%) underwent a type BII rotationplasty27 because of infection. Limb-salvage was achieved in 121 patients (75%).
Pelvic chondrosarcoma
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