[Surgical treatment of bone and soft tissue tumors in the sacroiliac area--low- and high-grade neoplasms]

Abstract

Operative treatment of tumors in the sacroiliac area is very difficult for the orthopedic surgeon. We reviewed low- and high-grade neoplasms in the sacrum and part of the ilium. Primary bone tumors were giant cell tumor, chondrosarcoma and others; invading bone tumors were carcinoma, rhabdomyosarcoma and others; soft tissue tumors were liposarcoma, metastasis of extraskeletal chondrosarcoma and others; total, 19 cases. The preoperative treatment performed was embolization, intra-arterial infusion (chemotherapy) and radiation therapy. The surgical approach used were the posterior, posterolateral, anterior and posterior, anterior and lateral combined approach. The transiliac procedure using the posterolateral approach gives better visualization adjacent to the sacroiliac area. The gap between the sacrum and the ilium is bridged by grafting the resected ilium. The anterior and lateral combined approach was used in the resection of large iliac tumors, and the abdominoinguinal approach was selected for large retroperitoneal tumors. The surgical treatment performed ranged from simple to wide excision, including the external iliac vessels or rectum, and also palliative surgery. Reconstructive surgery was done for reconstruction of the pelvic ring, spinal fusion using instrumentation and replacement of artificial vessels. Many complications and functional loss requiring treatment were encountered.