Analysis of surgical and oncological Outcome in internal and external Hemipelvectomy in 34 Patients above the Age of 65 Years at a mean Follow-up of 56 Months

Background: With an increasing life expectancy and improved treatment regimens for primary or secondary malignant diseases of soft tissue or bone, hemipelvectomy will have to be considered more often in elderly patients in the future. Scientific reviews concerned with the surgical and oncological ou...

Authors: Guder, Wiebke
Hardes, Jendrik
Gosheger, Georg
Henrichs, Marcel-Philipp
Nottrott, Markus
Streitbürger, Arne
Division/Institute:FB 05: Medizinische Fakultät
Document types:Article
Media types:Text
Publication date:2015
Date of publication on miami:27.02.2015
Modification date:16.04.2019
Edition statement:[Electronic ed.]
Source:BMC Musculoskeletal Disorders 16 (2015) 33, 1-9
Subjects:Hemipelvectomy; Hindquarter amputation; Elderly patients
DDC Subject:610: Medizin und Gesundheit
License:CC BY 4.0
Language:English
Notes:Finanziert durch den Open-Access-Publikationsfonds 2014/2015 der Deutschen Forschungsgemeinschaft (DFG) und der Westfälischen Wilhelms-Universität Münster (WWU Münster).
Format:PDF document
ISSN:1471-2474
URN:urn:nbn:de:hbz:6-00349719746
Permalink:http://nbn-resolving.de/urn:nbn:de:hbz:6-00349719746
Other Identifiers:DOI: doi:10.1186/s12891-015-0494-5
Digital documents:s12891-015-0494-5.pdf
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520 3 |a Background: With an increasing life expectancy and improved treatment regimens for primary or secondary malignant diseases of soft tissue or bone, hemipelvectomy will have to be considered more often in elderly patients in the future. Scientific reviews concerned with the surgical and oncological outcome of elderly patients undergoing hemipelvectomy are scarce. Therefore, it is the purpose of this study to review the outcome of patients treated with that procedure at our hospital and investigate the feasibility of such extensive procedures at an increased age. Methods: A retrospective analysis of thirty-four patients who underwent hemipelvectomy at an age of 65 years or older was performed to determine their surgical and oncological outcome. The Kaplan-Meier method was used to calculate the cumulative probability of survival using the day of tumor resection as a starting point. Univariate analysis was carried out to investigate the influence of a particular single parameter. Results: The mean age at operation was 70.2 years. Thirty patients were treated for intermediate- to high-grade sarcoma and 81.8% of tumors were larger than or equal to 10 cm in the longest diameter. Thirteen patients underwent internal hemipelvectomy and nine patients external hemipelvectomy as a primary procedure. Twelve patients were treated with external hemipelvectomy after failed local tumor control at primary operation. Wound infection occurred in 61.7% of cases. Three patients underwent amputation for non-manageable infection after internal hemipelvectomy. Hospital mortality was 8.8%. Clear resection margins were obtained in 88% of patients; in another 6% of patients planned intralesional resections were performed. Local recurrence occurred in 8.8% of patients at a mean time of 26 months after operation. Eleven patients are alive with no evidence of disease and 23 patients died of disease or other causes. Patients with pulmonary metastases had a mean survival period after operation to DOD of 22 months compared to 37 months in the curative group. Conclusion: Despite an elevated rate in hospital mortality and wound infection, this study suggests that hemipelvectomy is feasible in elderly patients, although requiring long hospitalization periods and causing a limited functional outcome.<br> 
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