Challenging intraoperative management of pelvic resection type I,II on 33 years old woman with pelvic osteosarcoma Enneking 2B: A case report

Doli Mauliate Sitompul (Orthopaedi and Traumatology Department Ciptomangunkusumo Hospital, Universitas Indonesia, Jakarta)
Yogi Prabowo (Consultant of Oncology Division, Orthopaedi and Traumatology Department Ciptomangunkusumo Hospital, Universitas Indonesia, Jakarta)

Jurnal Kedokteran dan Kesehatan : Publikasi Ilmiah Fakultas Kedokteran Universitas Sriwijaya
Vol. 4 No. 3 (2017): Jurnal Kedokteran dan Kesehatan : Publikasi Ilmiah Fakultas Kedokteran Universi

Pelvic osteosarcomas are considerably rare compare to other lession of osteosarcoma. The anatomic proximity of thepelvis to many neurovascular structures and the urinary and intestinal tracts become a challenge of surgical procedureduring excision and reconstruction. Resectability of the tumor determined through the size, extend of the lessionthrough the pelvic and involvement of visceral organ or local infiltration. The prognosis had also became dismal due tothe danger of the surgical procedure and unsatisfying outcome postoperatively. In this report, we had follow a 33 yearsold woman with pelvic osteosarcoma after massive resection type I, II. Six month follow up show promising outcomethough massive bleeding caused by the massive excision and reconstruction of the pelvis. This case presented is aoperative procedure on pelvic osteosarcoma Enneking 2B with two step operation for resection and reconstruction,these procedure fight against massive bleeding (11 liters on the first stage), challenging anatomic reconstruction ofpelvic structure to restore the function and prolonged time of operation. Non vascularized fibular graft obtained andfixated bridging the promontorium to acetabulum to restore the weightbearing axis, followed with arthrodesis of theright hip using reconplate size 3.5 mm, 14 hole. The procedure performed for the case consist of 2 stage operation. Firststage, the resection consist of resection of right iliac wing and right periacetabulum region. During the procedure, theavailability of packed red cell considerably important, due to massive bleeding exceeded to 11 liters. During the secondstage, the reconstruction took more attention about the inflammed soft tissue. Outcome evaluation presentedpostoperatively, 1 month and 6 month, show better result MSTS score on evaluation during postoperative to 6 monthevaluation. Radiologic evaluation also show the conveniance fixation without any sign of reccurence. As studies haveshown that limb-salvage techniques and the amputation show no difference in terms of the survival rate of patients withmalignant bone tumors, the limb-salvage techniques are now being frequently used even for cases of advanced tumors.Therefore, when an extensive operation is necessary, careful preoperative planning followed with adequateintraoperative management according to the tumor location would be helpful in reducing the danger with satisfyingresult.