Chondrosarcoma pelvis, beyond the boundaries.

Abstract

Objectives: The objective of our study to find the outcome of extensive chondrosarcoma pelvis after surgery. Study Design: Case Series study. Setting: Department of Orthopaedic Surgery Dow University of Health Sciences / Civil Hospital Karachi. Period: From April 2014 to December 2018. Material & Methods: Seven patients with Chondrosarcoma pelvis included in this study. Results: All Seven patients were male. 2 patient age was in 20’s, three in 40’s and two in 60’s with median age of 44. Clinically presentation of patients was variable. One patient present with groin lump, one with pain and swelling lower abdomen, three with hip pain, one patient with severe gluteal pain and lump, one with massive lump extending from the mid abdomen to groin and urine retention and constipation. Five patients have left pelvis involved and two have right side. Two patients have pubic bone and ischium (Level III) involved, two have ilium (Level I) and three have ilium, acetabulum and pubis (Level I, II, III). Two patients with have preoperatively sciatic nerve palsy. Two patients have medical comorbid. One was asthmatic and one had psychiatric illness. No patient had metastasis at presentation. Pubis and ischium with tumor resected in two cases, partial ilium resection in one case, one complete P1 resection with sciatic nerve, one patient have internal hemipelvectomy and one patient had internal hemipelvectomy that bone recycled in liquid nitrogen and pelvis re-implanted and fixed with recon plates and hip joint reconstructed with total hip replacement. One patient had external hemipelvectomy due to pus at tumor site. Total duration of surgery in patient having thirteen hours, and remaining have 3 to 5 hours. Blood loss during these surgeries was in between 1000 to 1200 ml. Three patients have wound infection, one patient had L5 nerve root injury. Patient with external hemipelvectomy develop wound dehiscence and uro-cutaneous fistula. Two patients died, one with recycled bone after 15 months due cardiac problem and 2^nd due to disease related complications within 3 months of surgery. Conclusion: Pelvic chondrosarcoma must be operated by the team of surgeons including orthopaedic surgeon, urologist and general surgeon because of the tumor presents with massive lumps due to unrestricted compartment and can involve the important pelvic organ. With team any complication can be prevented and treated immediately.