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Long-Term Follow-Up of Microsurgical Reconstruction for Pelvic Tumor Focusing on Spinal Deformity and Quality of Life

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DOI: 10.4236/jct.2014.54042    2,960 Downloads   3,745 Views  

ABSTRACT

Background: To provide patients with a superior quality of life (QOL) after their pelvic tumor resection, ensuring the stability of the trunk as well as satisfactory lower extremity function is important. Although microsurgical reconstructions for the pelvic ring and hip are used clinically, the details of postoperative long-term spinal deformity and QOL remain unclear. Methods: The patients were 66- and 43-year-old men and a 43-year-old woman. The mean postoperative follow-up period was 134 months. The surgical procedures performed on these patients were: pelvic ring reconstruction using a double-barreled free vascularized fibular graft (FVFG) in Patient 1; simultaneous pelvic ring reconstruction using FVFG and hip arthrodesis in Patient 2; and latissimus dorsi free flap without pelvic ring reconstruction in Patient 3. As indicators of spinal deformity, we measured the Cobb angle, thoracic kyphosis angle, lumbar lordosis angle, pelvic angle on the sagittal plane, and sagittal plane balance using whole spine radiography. To assess the patients’ QOL, we examined the International Society of Limb Salvage (ISOLS) score, the Roland-Morris Disability Questionnaire (RDQ), activities of daily living (ADL) satisfaction using a visual analogue scale (VAS), and the SF-36. Results: Spinal alignment in the frontal plane worsened in order from Patient 1 to 3. Spinal alignment and pelvic tilt in the sagittal plane were at appropriate levels in Patients 1 and 2. The trunk tilt in the sagittal plane was at an appropriate level only in Patient 1. In the QOL assessment, the function of the affected limb worsened in order from Patient 1 to 3. RDQ scores were lower than the national norm in Patients 2 and 3. With respect to ADL satisfaction and the SF-36, Patient 3 had a markedly low VAS, physical functioning, role-physical, and role-emotional scores. Conclusion: In the long-term clinical course after pelvic tumor resection, in order to obtain satisfactory spinal alignment and QOL, pelvic ring reconstruction and hip arthrodesis are important.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Ejiri, S. , Kikuchi, S. , Tajino, T. , Kawakami, R. , Hakozaki, M. and Konno, S. (2014) Long-Term Follow-Up of Microsurgical Reconstruction for Pelvic Tumor Focusing on Spinal Deformity and Quality of Life. Journal of Cancer Therapy, 5, 354-362. doi: 10.4236/jct.2014.54042.

References

[1] Nagoya, S., Usui, M., Ishii, S., et al. (2000) Reconstruction and Limb Salvage Using a Free Vascularised Fibular Graft for Periacetablar Malignant Bone Tumors. Journal of Bone & Joint Surgery, British Volume, 82, 1121-1124. http://dx.doi.org/10.1302/0301-620X.82B8.11004
[2] Enneking, W.F., Spanier, S.S. and Goodman, M.A. (1980) A System for the Surgical Staging of Musculoskeletal Sarcoma. Clinical Orthopaedics and Related Research, 153, 106-120.
[3] Enneking, W.F., Dunham, W.K., Gebhardt, M.C., et al. (1993) A System of the Functional Evaluation of Reconstructive Procedures after Surgical Treatment of Tumors of the Musculoskeletal System. Clinical Orthopaedics and Related Research, 286, 241-246.
[4] Offierski, C.M.. and MacNab, I. (1983) Hip-Spine Syndrome. Spine, 8, 316-321.
http://dx.doi.org/10.1097/00007632-198304000-00014
[5] Jackson, R.P., Peterson, M.D., McManus, A.C., et al. (1998) Compensatory Spinopelvic Balance over the Hip Axis and Better Reliability in Measuring Lordosis to the Pelvic Radius on Standing Lateral Radiographs of Adult Volunteers and Patients. Spine, 23, 1750-1767.
http://dx.doi.org/10.1097/00007632-199808150-00008
[6] Jackson, R.P. and McManus, A.C. (1994) Radiographic Analysis of Sagittal Plane Alignment and Balance in Standing Volunteers and Patients with Low Back Pain Matched for Age, Sex, and Size. A Prospective Controlled Clinical Study. Spine, 19, 1611-1618. http://dx.doi.org/10.1097/00007632-199407001-00010
[7] Kanemura, T., Satake, K., Yamaguchi, H., et al. (2013) Sagittal Spino-Pelvic Alignment in an Asymptomatic Japanese Population (in Japanese). Orthopaedic Surgery & Traumatology, 56, 805-814.
[8] Uchida, A., Myoui, A., Araki, N., et al. (1996) Prosthetic Reconstruction for Periacetablar Malignant Tumors. Clinical Orthopaedics, 326, 238-245. http://dx.doi.org/10.1097/00003086-199605000-00029
[9] Harrington, KD. (1992) The Use of Hemipelvic Allografts or Autoclaved Grafts for Reconstruction after Wide Resection of Malignant Tumors of the Pelvis. Journal of Bone & Joint Surgery, 74, 331-341.
[10] Myoui, A., Araki, N., Ueda, T., et al. (2002) Clinical Results of the Intraoperative Extracorporeal Autogenous Irradiated Bone Graft. Journal of the Japanese Orthopaedic Association, 76, S828.

  
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