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    Mid-term outcomes of hemipelvic allograft reconstruction after pelvic bone tumor resections
    (Turkish Joint Diseases Foundation, 2022) Kekec, Ahmet Fevzi; Gungor, Bedii Safak
    Objectives: This study aims to evaluate survival of patients and implants, functions, and morbidity of surgical technique of reconstruction with a fresh-frozen massive pelvic allograft following a pelvic resection. Patients and methods: Between January 2009 and December 2016, a total of 19 patients (12 males, 7 females; mean age: 35.8 +/- 14.4 years; range, 10 to 53 years) who underwent reconstruction with fresh-frozen massive allograft after internal hemipelvectomy were retrospectively analyzed. Patients. age, sex, resection types, histopathology and grades, surgical margins, operative times, intraoperative blood loss, complications experienced during their treatment (infection, dislocation, implant failure, nonunion, local recurrence and metastasis), neoadjuvant and adjuvant therapies they received, and functional scores were revelaed and analyzed in 10 years period. Results: According to the Enneking and Dunham classification, two (10%) patients had type I resection only, six (32%) had type I-II, one (5%) had a type II resection, one (5%) had type II-III resection, three (16%) had type I-II-III resection, one (5%) had type I-IV resection, and five (26%) had type I-II-IV resection. The resection involved the acetabulum (type II) in all, but three patients. Several complications were seen in 12 patients, although seven patients had no complication. Pelvic resections had a high mortality rate in patients with malignant tumors and reconstruction with massive allograft had a high morbidity rate with susceptibility to many complications. Prolonged surgical time was found to be directly related to blood loss. Deep infection significantly worsened functional results. Conclusion: Despite the high complication rates seen in pelvic resections, massive pelvic allografts represent a valid option for reconstruction after resection of pelvic tumors, but due to the associated morbidity, patients should be carefully selected.
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    Outcomes of Planned Marginal and Wide Resection of Sarcomas Associated with Major Vascular Structures in Extremities
    (Springer India, 2022) Kekec, Ahmet Fevzi; Gunaydin, Ilknur; Ozturk, Recep; Gungor, Bedii Safak
    Bone and soft tissue sarcomas of lower and upper extremities may sometimes be in close contact with neurovascular structures. In such cases, it is controversial that whether en bloc resection and vascular reconstruction to reach wider surgical margins or planned marginal resection with the help of adjuvant therapies should be preferred. This study aimed to determine surgical and oncological outcomes of planned marginal and wide resection of extremity sarcomas that are associated with major vascular structures in the extremities. The collected database of 54 patients treated by the same orthopedic and vascular surgeon for primary or locally recurrent soft and bone tissue sarcoma of extremities was retrospectively reviewed. Eligible subjects for this study were patients diagnosed with upper and lower extremity soft and bone tissue sarcomas that encased a maximum of 50% of the circumference of the major vascular structures, requiring limb-sparing resection. When microscopic positive (19 patients, 33.9%) and negative cases' (35 patients, 66.1%) surgical margins were compared, local recurrence, metastasis, amputation, and tumor type (soft/bone) parameters showed no statistically significant difference. When metastatic and non-metastatic patients were compared, it was shown that bone tumors metastasized more than soft tissue tumors (p = 0.001). However, there was no difference between metastasis and amputation, histopathology, grade, nerve involvement, surgical margins, or local recurrences. The mean survival was 1460.6 +/- 137.4 days, and the 6-year mortality was 87.5%. Anesthetic and surgical complication rates may be higher since en bloc resection surgeries of large tumors with vascular reconstructions take a very long time. Therefore, we suggest marginal resection with sub-adventitial dissection in those locations and wide resection at other areas according to the surgeon's experiences about safe margin with the contribution of radiotherapy.