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Open Access Review

En bloc resection of extra-peritoneal soft tissue neoplasms incorporating a type III internal hemipelvectomy: a novel approach

Sanjay S Reddy1* and Norman D Bloom2

Author Affiliations

1 Fox Chase Cancer Center, Department of Surgical Oncology, 333 Cottman Avenue, Philadelphia, PA 19102, USA

2 Beth Israel Medical Center, Department of Surgery, 1st avenue at 16th street, New York, NY, 10003, USA

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World Journal of Surgical Oncology 2012, 10:222  doi:10.1186/1477-7819-10-222

Published: 25 October 2012

Abstract

Background

A type III hemipelvectomy has been utilized for the resection of tumors arising from the superior or inferior pubic rami.

Methods

In eight patients, we incorporated a type III internal hemipelvectomy to achieve an en bloc R0 resection for tumors extending through the obturator foramen or into the ischiorectal fossa. The pelvic ring was reconstructed utilizing marlex mesh. This allowed for pelvic stability and abdominal wall reconstruction with obliteration of the obturator space to prevent herniations.

Results

All eight patients had an R0 resection with an overall survival of 88% and with average follow up of 9.5 years. Functional evaluation utilizing the Enneking classification system, which evaluates motion, pain, stability and strength of the affected extremity, revealed a 62% excellent result and a 37% good result. No significant complications were associated with the operative procedure. Marlex mesh reconstruction provided pelvic stability and eliminated all hernial defects.

Conclusion

The superior and inferior pubic rami provide a barrier to a resection for tumors that arise in the extra-peritoneal pelvis extending through the obturator foramen or ischiorectal fossa. Incorporating a type III internal hemipelvectomy with a simple marlex mesh reconstruction allows for complete tumor resection without functional compromise, acute infectious issues, obturator or abdominal hernia defects.