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Surgical Management of Pelvic Sarcoma in Children

Dr. Hosalkar is Clinical Instructor and Administrative Chief Resident, Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA. Dr. Dormans is Chief, Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, and Professor of Orthopaedic Surgery, University of Pennsylvania, School of Medicine.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Hosalkar and Dr. Dormans.

Reprint requests: Dr. Dormans, Orthopaedic Surgery, University of Pennsylvania, School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399.

Survival rates of children with pelvic sarcoma have demonstrated unprecedented improvement during the past few decades, with a corresponding increase in the number of limb-sparing surgical procedures being performed. This increase may be attributed to earlier detection with advanced imaging techniques, the availability of a wider armamentarium of surgical techniques of reconstruction and limb salvage, and advances achieved in neoadjuvant chemotherapy and radiation therapy. Undertaking reconstruction after resection of pelvic sarcoma while preserving function of the hip and limb can be extremely challenging; this is especially true in children, who invite concern regarding growth potential and limb-length discrepancy. Decisions for surgery and reconstruction are individualized based on tumor type, size, and location as well as the probability of achieving a wide resection with negative margins and acceptable morbidity.