Complications of PI to PIII hemipelvic resections for intermediate and malignant tumours : a systematic review and meta-analysis.
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Smolle Maria A, Wenzl Florian A, Laitinen Minna K, Jeys Lee M, BOOM Consortium, Leithner Andreas, Abdul Bari Yunus, Abood Ahmed, Abraham John, Acosta Marthelena, Agarwal Rishi, Agarwal Manish, Ajit Singh Vivek, Akiyama Toru, Al Farii Humaid, Aldosari Omar A, Alfaro Patricio, Aljuhani Wazzan, Allison Daniel, Almashahedi Mohammed, Alotaibi Abdullah, Alpan Bugra, Alshaygy Ibrahim S, Althunayan Turki, Andreani Lorenzo, Andreou Dimosthenis, Andriandi Andriandi, Annabell Lucas, Aponte-Tinao Luis, Armas Selma, Aston William, Aycan Osman Emre, Baad-Hansen Thomas, Baird Charles, Balach Tessa, Barriga Juan Alfonso, Barry Janie, Basile Georges, Bastoni Stefano, Basuki Mohammad Hardian, Bauer Henrik, Bayliss Lee, Becker Ricardo, Bedi Angad, Benevenia Joseph, Bengoa Francisco, Berger Christina, Bernthal Nicholas, Binitie Odion, Bird Justin E, Bobseit Abdulrahman, Bodian Caitlin, Boffano Michele, Bonilla Huertas Patricia, Botello Eduardo, Boyle Richard, Bramer Jos, Broekhuis Demien, Broida Samuel E, Brown Danielle, Budny Tymoteusz, Burke Zachary, Cabrolier Jorge, Calvo Haro Jose Antonio, Campanacci Domenico Andrea, Cardoso Rodrigo, Carey Smith Richard, Casales Fresenga Nicolas, Ceballos Oscar, Chan Chung Ming, Chan Lester, Choong Peter, Chrobok Adam, Chung Yang-Guk, Ciechanowicz Dawid, Clara-Altamirano Miguel Angel, Consuegra Luis, Courtot Louis, Crawford Brooke, Cribb Gillian, Cuervo-Lozano Carlos Eduardo, Dammerer Dietmar, de la Rosa Pablo, De Paolis Massimiliano, De Santos de la Fuente Francisco Javier, de Vaal Marieke, Deisenhofer Julian, Delgado Javier, Deo Shaneel, Deventer Niklas, Di Bella Claudia, Dierselhuis Edwin, Domson Gregory, Donati Davide Maria, Duran-Ciarrochi Rodolfo, Durr Hans Roland, Ebeid Walid, Ehlers Pierre, El Ghoneimy Ahmed Mohamed, El Motassime Alessandro, Eloi Pinto Fabio Fernando, Endo Makoto, Epstein Gadi, Eralp Levent, Etaiwi Mahmoud, Eward Will, Fabbri Nicola, Faimali Martina, Farooq Arbab, Farooque Khalil, Ferguson Peter, Ferreira Nando, Fiorenza Fabrice, Fonseca de Freitas Joao, Forsberg Jonathan A, Fuchs Bruno, Fujiwara Tomohiro, Funovics P T, Fuzy Edward, Galli Serra Marcos, Gamie Zakareya, Garcia Carrasco Maria, Gaston Czar Louie, Georges Basile, Ghert Michelle, Ghert Michelle, Ghosh Kanishka, Giardina Fabio Luca, Gomez Mier Luis Carlos, Gomez-Mascard Anne, Gomez-Sierra Maria Antonia, Goodman Mthethwa Phakamani, Gortzak Yair, Goulding Krista, Gracia Isidro, Green Natalie, Griffin Anthony, Guedes Alex, Gulia Ashish, Gupta Sanjay, Guzman Maurice, Hardes Jendrik, Hasan Yusuf O, Havard Hel, Haydon Rex, Hegde Prateek, Hernandez Lopez Adriana, Herrera David, Hesla Asle, Hess Matthew, Hilton Thomas, Hirschmann Adam, Hobusch Gerhard, Hongsaprabhas Chindanai, Hornicek Francis, Hosking Keith, Houdek Matthew T, Hsu Megan, Idowu Oluwaseyi, Idulhaq Mujaddid, Ippolito Joseph, Iwata Shintaro, Jagiello Jake, Jeys Lee, Johan Muhammad Phetrus, Johnson Luke, Johnston Andy, Joo Min Wook, Jutte Paul, Jääskeläinen Anna-Stina, Kaldas Kadri, Kapanci Bilal, Karaca Mustafa Onur, Kawai Akira, Kemp Alysia, Khal Adyb- Adrian, Khan Zeeshan, Khan Zainab Aqeel, Kim Han-Soo, Klopper Schalk, Kobayashi Eisuke, Kobayashi Hiroshi, Kontogeorgakos Vasileios, Kotrych Daniel, Krishnamurthy Anjan Venkataraman, Kunisada Toshiyuki, Kurisunkal Vineet, Kyte Richard, Laitinen Minna, Laubscher Maritz, Lazarides Alexander, Le Nail Louis-Romee, Lee Francis Y, Legosz Pawel, Lehner Burkhard, Leithner Andreas, Leone Gianpaolo, Lewis Valerae O, Li Binghao, Liikanen Hanna, Lin Peng, Linda Zwelithini, Lindsay Sarah, Lozano Calderon Santiago, Lutomia Lumbasi Mark, MacDonald Jonathan, Malina Mario, Marais Len, Mascard Eric, Mattei Jean-Camille, McCullough Louise, McMahon Sam, Medellin Rincon Manuel Ricardo, Mediavilla Santos Lidya, Meijer Diederik, Meijer Johannes Gerard, Miller Ben, Molloy Allan, Moriel Garcesco Diego Jesus, Morris Guy, Morris Carol D, Morse-Sanyal Ashlyn, Mottard Sophie, Munir Hashim Ahmad, Murcia Miguel, Müller Michelle, Nakayama Robert, Narhari Prashant, Nasar Ali, Nayak Prakash, Neugebauer Johannes, Nieminen Jyrki, Ntombela Philani, Nystrom Lukas, O'Toole Gary, Ogura Koichi, Oliveira Vania, Olivier André, Omar Mohamed, Omran Hasan Yusuf, Ortiz-Cruz Eduardo, Ozaki Shuhei, Ozaki Toshifumi, Pala Elisa, Palmerini Emanuela, Panchwagh Yogesh, Papagelopoulos Panayiotis, Papagelopoulos Dimitra, Paraliticci Giovanni, Gibbs C Parker, Parry Michael, Peiró Ana, Perera Jonathan, Petersen Michael Moerk, Phakathi Oatile, Phimolsarnti Rapin, Phiri Tshepang, Pinto Santander Nicolas, Ploegmakers Joris, Pollock Robin, Powell Gerard, Pruthi Manish, Puhaindran Mark, Puri Ajay, Quirion Julia, Rabin Eden, Rachbauer Anna, Radhakrishnan Sanjeevan, Raja Anand, Rajalbandi Rohit, Rajani Rajiv, Rajasekaran Raja Bhaskara, Rajkovic Stanislav, Ramkumar Dipak, Rankin Kenneth, Ras El Abiad Mejia Alejandro, Rasappan Kumaran, Redl Malena, Rose Peter S, Rosenberg Andrew, Ruggieri Pietro, Russell Michael, Salcedo German, Saleh Ahmad, Sambri Andrea, Saputra Rhyan Darma, Scanferla Roberto, Scharschmidt Thomas, Schubert Thomas, Scoccianti Guido, Segura Florencio, Sellevold Simen, Rajasekaran Shanmuganthan, Shehadeh Ahmad, Shreemal Bhim, Shumelinsky Félix, Siddiqi Muhammad Ather, Silveri Claudio, Sinnaeve Friedl, Smolle Maria Anna, Snyman Franz, Solomons Michael, Sommerville Scott, Sood Sahil Sood, Spense Mariel Eliana, Spiegel Christian, Spiguel Andre, Staals Eric, Stavropoulos Nikolaos, Steadman Peter, Stern Sydney, Stevenson Jonathan, Stoppiello Pablo, Sullivan Mikaela H, Szostakowski Bartlomiej, Szostakowski Bartek, Tang Xiaodong, Thippesamy Pushpa B, Thorkildsen Joachim, Tootsi Kaspar, Torner Rubies Ferran, Tosyali Koray, Traub Frank, Trent Jonathan C, Trikoupis Ioannis, Tsagkozis Panagiotis, Tuntarattanapong Pakjai, Ullah Farman, Ulrich Marisa N, Vainio Veli-Matti, Valencia Juan, van de Sande Michiel, Van Der Geest Ingrid, van der Wal Robert, Velez Villa Roberto, Verbeke Léonie, Verspoor Floortje G M, Versteeg Anne, Vicatos George, Virk Jagandeep Singh, Visgauss Julia, Vyrva Oleg, Wafa Hazem, Wan Faisham Numan Wan Ismail, Wang Patrick Qi, Wei Ran, Wennergren David, Werier Joel, Weschenfelder Wolfram, Williams Nadine, Wunder Jay, Yildiz Huseyin Yusuf, Yonamine Eduardo, Yonezawa Hirotaka, Yousuf Maitham, Zainul Abidin Suraya, Zamora Tomas, Zuckerman Lee, Zumarraga Juan Pablo, Özger Harzem, Özkan Korhan, Triganjananun Chanonta, Aguirre Marcela, Alaqeel Motaz, Alaseem Abdulrahman, Alexander Kate, Ardelt Melanie, Baeza Pablo, Banse Xavier, Franks Daniel, Baydar Semay, Doshi Arpan, Bruschi Alessandro, Buist Mirka, Busse Tilmann, Carrasco María, Castan Ashley, Chang Liang, Charoenlap Chris, Chaustre Florez, Chin Janet, Pate Matthew, Olson Daniel, Cornu Olivier, Farris Clayton, de Lima, Demir Eren, Docquier Pierre-Louis, Duivenvoorden Myléne, Farman Ullah, Flint Michael, García-Huidobro Gabriel, Gazendam Aaron, Golovina Yanina, Gomez M Luis Carlos, González-Browne Catalina, Gonzalez-Saldivar Juan Carlos, González-Motta Alejandro, Gosheger Georg, Gouin Francois, Graydon Andrew, Hesham Amr, Hohensteiner Anna, Igbinoba Bright, Joyce David, Letson Douglas, Tepper Sarah, Jung Beatrice, Jungels Christiane, Jutte Willem, Khan Zainab Aqeel, Khaouam Nader, Krebbekx Gitte, Lacroix Valérie, Lee Jewoo, Lee Minpyo, Machado Pau, Majirija Edgar, Malyk Roman, Mthethwa Phakamani G, Muñoz-Montecinos Carlos, Quirland Camila, Ramirez Maria, O'Reilly-Harbidge Sarah, Oktayana Made Dolly, Olusunmade Opeyemi, Pang Grant, Stubbe Chris, Parizzia Walter, Pinheiro Rafael, Prabowo Yuni, Ramkumar Dipak B, Rizzo Arianna, Samy Ahmed, Sánchez-Maldonado Maria, Sundin Nathalia, Suntaxi Basantes, Tandon Nikhil, Terrarossa Bruno, Trullols Laura, Tsoi Kim, Zaghloul Ahmed
Аннотация
METHODS: Based on a systematic literature search on PubMed adhering to the PRISMA guidelines, 1,683 study records were identified, of which we included 90 original studies published until 22 July 2025. Overall complication rates were assessed with random-effects meta-analysis. Differences in complication rates between reconstruction types (i.e. megaprosthetic, mostly biological, none) were evaluated with meta regression analysis.
RESULTS: Data on 2,199 patients (1,250 males (57%)) with mainly PI to PIII pelvic resections were analyzed. The most common reconstruction types were custom-made implants (21%; n = 451) and ice-cream cone prostheses (14%; n = 312). Pooled rates of infections, wound healing problems, nerve injuries, and deep vein thrombosis (DVT) amounted to 15% (95% CI 12% to 18%), 13% (95% CI 10% to 15%), 7% (95% CI 5% to 9%), and 4% (95% CI 2% to 6%), respectively. Further, pooled implant revision/removal and secondary external hemipelvectomy rates were 14% (95% CI 11% to 17%) and 4% (95% CI 3% to 5%). Mostly biological reconstructions were associated with higher rates of nerve injuries (p < 0.001), construct failures (p = 0.010), and secondary implant revision/removal (p = 0.003) compared to megaprosthetic reconstruction. Further, biological reconstructions were associated with increased secondary external hemipelvectomy rates compared to megaprosthetic reconstructions (p = 0.005) or no reconstructions (p = 0.001).
CONCLUSION: Treatment of pelvic malignancies is challenging, with technically demanding resections and complex reconstructions. Across all reconstruction techniques following sacrum-sparing pelvic resections, infections and wound healing problems are the most common complications, yet there is also a considerable proportion of patients with neurovascular complications and DVTs.