Rescue surgery in chondrosarcoma of the pelvis

Abstract

Chondrosarcoma is more common in the pelvis, hip and shoulder. Five-year survival rates are as follows: 90% for low-grade (Grade I) tumors 81% for intermediate-grade (Grade II) tumors 29% for high-grade (Grade III) and dedifferentiated (grade IV) chondrosarcoma tumors , less than 10 percent of patients survive more than a year.

Case presentation: a 74-year-old male patient, with a pathological history of thalassemia, from the interior of the province of Córdoba, who consulted for pain and a fast-growing tumor in the pelvic region. On physical examination, he presented a palpable mass in the region of the left iliopubic branch, immobile, adhered to deep planes, accompanied by edema of the ipsilateral lower limb. A series of imaging studies (X-ray, soft tissue ultrasound, Doppler ultrasound, CT, Angio-CT, MRI, bone scan and PET) are requested and a CT-guided puncture-biopsy is performed due to suspicion of a malignant lesion. Dedifferentiated chondrosarcoma of the pelvis is diagnosed.

Surgical procedure: It is operated in conjunction with vascular surgery and urology teams, with the aim of the most extensive resection possible and local tumor control with limb conservation. The patient is positioned in the lateral Floppy position, an Enneking “utillitarian approach” type incision is made, with dissection of the great vessels from the pelvis to the thigh. We proceed with osteotomies for the resection of the tumor with free borders with guides previously customized for the case. A customized 3D prosthesis is placed with anchorage to the remaining pubic symphysis, ilium and ischium and to which a cemented double-mobility total hip replacement prosthesis is inserted. The anatomopathological study of the surgical piece confirmed dedifferentiated chondrosarcoma of the pelvis (grade IV). The patient had a survival of 11 months and 25 days with good quality of life.

The use of these 3d implants help the quality of survival of these patients.