Reconstruction with 3D-printed endoprostheses after type Ⅱ or Ⅱ+Ⅲ pelvic tumor resection: a retrospective case-control study

LIANG Hai-jie; GUO Wei; ZHANG Yi-dan; JI Tao

doi:10.3969/j.issn.2095-252X.2017.05.002

Abstract：Objective To investigate the feasibility and superiority of reconstruction using a 3D-printed pelvic endoprosthesis after type Ⅱ or Ⅱ+Ⅲ pelvic tumor resection. Methods Forty patients who received type Ⅱ or Ⅱ + Ⅲ tumor resection and functional reconstruction with 3D-printed pelvic endoprostheses in our center from Dec. 2014 to Nov. 2016 were included in the study group. Another 40 cases were selected as the control group from those receiving pelvic tumor resection and endoprosthetic reconstruction in our center between Jan. 2009 and May 2015, according to the gender, age, height, weight, tumor volume, Enneking's classification and staging of each case in the study group. There were 23 males and 17 females in each group, whose mean age was 43 years old. According to Enneking' division of pelvic surgery, the sites of resection and reconstruction were determined, with 6 cases of type Ⅱ and 34 cases of type Ⅱ + Ⅲ. Results All 80 patients underwent en bloc resection. In the study group, margins were wide in 22 cases and marginal in 18 cases. After a median follow-up of 9 months ( range: 3 to 25 months ), 33 patients survived without evidence of disease, 5 patients were alive with diseases and 2 patients died of distant metastasis. The average MSTS 93 score was 21.1 ± 2.8 for all of the 38 alive patients. Complications included 6 cases of delayed wound healing, 1 case of hip dislocation and no cases of deep infection. In the control group, margins were wide in 21 cases and marginal in 19 cases. After a median follow-up of 17.5 months ( range: 5 to 77 months ), 27 patients survived without evidence of disease, 5 patients were alive with diseases and 8 patients died of distant metastasis. The average MSTS 93 score was 18.9 ± 2.6 for all of the 32 alive patients. Complications included 6 cases of delayed wound healing, 2 cases of hip dislocation and 2 cases of deep infection. No statistical significances were seen between the 2 groups in regard to operative duration, intro-operative hemorrhage, complication profiles or functional scores. We reviewed the CT pelvic imaging of the patients at 6 months after the operation and compared the sacroiliac gap of the operative side with that of the contralateral side in both groups, which indicated that the 3D-printed pelvic endoprosthesis could preserve sacroiliac stability. Conclusions The application of 3D-printed pelvic endoprostheses for reconstruction after type Ⅱ or Ⅱ + Ⅲ resection is safe without additional complications, could achieve good functional results and preserve sacroiliac stability during short-term follow-up.