Separated-incision versus T-incision for internal hemipelvectomy related to Enneking type II + III resection: comparative outcomes in a single-center retrospective cohort

Abstract

Abstract Background The T-incision approach for internal hemipelvectomy necessitates extensive dissection to expose the posterior pelvic structures, leading to higher rates of wound complications. A modified separated-incision approach was developed and validated in this comparative study. Patients and methods The separated-incision approach used two distinct incisions: an anterior incision that combines the ilioinguinal approach with a short, straight Smith-Petersen incision; and a separated posterior incision for the posterior pelvic structures. This approach was applied to 8 patients with internal hemipelvectomy related to type II + III regions. Seventeen patients underwent a traditional T-incision approach during the same period were matched for comparison. Results The separated-incision approach was successfully performed in these eight patients, preserving the gluteal vessels and posterior skin-muscle flap. Lower blood loss (2375 vs. 3952 mL, p = 0.005), and similar operative time (312 vs. 398 min, p = 0.098) was observed. Postoperative haemoglobin was higher (88.1 vs. 74.8 g/L, p = 0.009), and drainage volumes were marginally reduced (1379 vs. 1917 mL, p = 0.209). Compared to 8 patients in the T-incision group who experienced wound complications including delayed wound healing (n = 4) and surgical site infection (n = 4), all patients in separated-incision group achieved primary wound healing within 3 weeks (47% vs. 0%, p = 0.026). Additionally, they had a shorter time to ambulation (39 vs. 62 days, p = 0.015) and higher MSTS scores (24.25 vs. 20.47, p = 0.006). No differences were observed in local recurrence or overall survival. Conclusions The separated-incision demonstrated fewer wound complications and faster mobilization, suggesting it is a promising alternative; multicentre validation is warranted. Level of evidence Level III, Retrospective cohort study.

Keywords

• Internal hemipelvectomy
• T-incision approach
• Wound complications
• Separated-incision
• Pelvic tumours