Surgical Treatment of Pelvic Chondrosarcoma Involving Periacetabulum

Background and Objectives: Surgical treatment of pelvic chondrosarcoma involving acetabulum is challenging. Primary goals of surgical treatment include local control and prevention of distant metastases. A secondary goal is maintenance of quality of life by avoiding major amputative surgery. The purpose of the study was to review the oncological outcome, functional outcome, and the surgical complications of patients with periacetabular chondrosarcomas in the context of resection and reconstruction treated at one tumor center in the past decade. Methods: Forty-five cases between June 1998 and June 2007 were retrospectively reviewed. There were 26 men and 19 women with an average age of 41.2 (18-63) years. Patients were followed up for a median time of 37 months (18-119 months). There were 32 patients with conventional chondrosarcomas. 9 with dedifferentiated chondrosarcomas, and 4 with mesenchymal chondrosarcomas. According to Enneking's classification there were: Type II-I. Type I + II-8, Type II + III-23 Type I + II + IV-8, and Type I + II + III-5. Six patients had an external hemipelvectomy, whereas 39 patients underwent a limb-salvage procedure. In 27 patients the defect was reconstructed by a modular hemipelvic endoprosthesis and in 4 patients reconstruction by saddle endoprosthesis. Five patients received reconstruction with devitalized tumor bone and three underwent iliofemoral arthrodesis. Results: The 5-year estimated survival was 62.6%. Local recurrence Occurred in 10 (22.2%) patients at an average of 18 months after operations. Ten (22.2%) patients had distant metastasis. The average MSTS 93 score was 68.3% (33.3-100). Eighteen complications occurred in 13 patients (28.9%). Wound complication occurred in six (13.3%) patients. Deep infection rate was 11.1%. Conclusions: Favorable oncological and functional outcome can be achieved in selected patients with periacetabular chondrosarcomas. The complication rates were still high: however, facing the goal of limb salvage, a certain number of complications is acceptable. J. Surg. Oncol. 2010:101:160-105. (C) 2009 Wiley-Liss, Inc.