TITLE:
Long-Term Follow-Up of Microsurgical Reconstruction for Pelvic Tumor Focusing on Spinal Deformity and Quality of Life
AUTHORS:
Soichi Ejiri, Shin-ichi Kikuchi, Takahiro Tajino, Ryoichi Kawakami, Michiyuki Hakozaki, Shin-ichi Konno
KEYWORDS:
Pelvic Tumor, Pelvic Ring Reconstruction, Quality of Life, Spinal Deformity, Vascularized Fibular Graft
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.5 No.4,
March
31,
2014
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.