RESUMO
Computer-assisted navigation and robotic surgery have gained popularity in the treatment of pelvic bone malignancies, given the complexity of the bony pelvis, the proximity of numerous vital structures, and the historical challenges of pelvic bone tumor surgery. Initial interest was on enhancing the accuracy in sarcoma resection by improving the quality of surgical margins and decreasing the incidence of local recurrences. Several studies have shown an association between intraoperative navigation and increased incidence of negative margin bone resection, but long-term outcomes of navigation in pelvic bone tumor resection have yet to be established. Historically, mechanical stabilization of pelvic bone metastases has been limited to Harrington-type total hip arthroplasty for disabling periacetabular disease, but more recently, computer-assisted surgery has been employed for minimally invasive percutaneous fixation and stabilization; although still in its incipient stages, this procedure is potentially appealing for treating patients with bone metastases to the pelvis. The authors review the literature on navigation for the treatment of primary and metastatic tumors of the pelvic bone and discuss the best practices and limitations of these techniques.
RESUMO
The treatment of patients with painful metastases and pathologic fracture of the pelvis is challenging and based on multidisciplinary approach. Although radiation and disease-specific systemic therapy are the mainstay of treatment, the goal of surgery is to maintain functional independence. Harrington-type total hip arthroplasty has proven invaluable to address periacetabular cancer. However, data on how to best treat patients with disabling pain due to metastases outside the periacetabular region or involving the entire hemipelvis are scant, heterogeneous, and hardly comparable. Minimally invasive strategies in this setting are appealing and conceivably preferable to open surgery because of lower risk of complications and expedited recovery.
