Pelvic Tumor Surgery in Children

Pediatric pelvic tumors are challenging because a surgeon must balance the challenges of treating a child, who is likely to have a better response to preoperative chemotherapy, with the challenges of resecting and reconstructing a tumor in the immature skeleton. Because young children typically have a far better preoperative chemotherapy response than most adults and young adults, they are often candidates for a smaller, more conservative tumor resection than the typical adult. The extent of the resection should be based on a careful preoperative assessment of the response to preoperative chemotherapy, as demonstrated by a comparison of preoperative MRI and PET scan imaging. Pediatric allografts can be an excellent reconstructive option for pelvic resections, which have a greater likelihood of healing in children. Patients under age 10 years may be candidates for nonoperative resection of their primary tumor because of a good response to chemotherapy. Surgical complications vary by multiple factors including tumor size, the type of resection and reconstruction, the age of patient, the length of the surgery and extent of surgical blood loss, and the surgeon’s experience. Tumor recurrence is a greater risk after pelvic resections than after extremity resections, and careful diligence in the documentation of operative margins is critical. Careful preoperative planning and preoperative discussions are an essential requirement for a good postoperative result.