Surgical resection and reconstruction after resection of tumors involving the sacropelvic region

Varga, Péter Pál and Szövérfi, Zsolt and Lazáry, Áron (2014) Surgical resection and reconstruction after resection of tumors involving the sacropelvic region. Neurological Research, 36 (6). pp. 588-596. ISSN 0161-6412

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Abstract

Objectives Surgical management of the tumors in the sacropelvic region is a challenging field of spine surgery because of the complex local anatomy and biomechanics. Recent development in anesthesia and intensive care has allowed us to perform extended surgeries focused on the en bloc resection of sacropelvic tumors. Various techniques for the resection and for the reconstruction were published in the last decade. Methods Sacropelvic tumor resection techniques and methods for the biomechanical and soft-tissue reconstruction are reviewed in this paper. Results Literature data is based on case reports and case-series. Several different techniques were developed for the lumbopelvic stabilization after sacropelvic tumor resection according to three different reconstruction principles (spinopelvic fixation, posterior pelvic ring fixation, anterior spinal column fixation); however, long term follow up data and comparative studies of the different techniques are still missing. Soft-tissue reconstruction can be performed according to an algorithm depending on the surgical approach, but relatively high complication rates are reported with all reconstruction strategies. The clinical outcome of such surgeries should ideally be evaluated in three dimensions; surgical-, oncological-, and functional outcomes. The last, and most important step of the presurgical planning procedure is a careful presentation of the surgical goals and risks to the patient, who must provide a fully informed consent before surgery can proceed. Discussion Sacropelvic tumors are rare conditions. In the last decade, growing evidence was published on resection and reconstruction techniques for these tumors; however, experience at most medical centers is limited by the low case-number. Formation of international expert groups and initiation of multicenter studies is strongly encouraged to produce a high level of evidence in this special field of spine surgery.

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