Development and External Validation of a Prognostic Staging System for Predicting Wound Complication after Internal Hemipelvectomy: An International Multicenter Study

Journal of the American College of Surgeons, vol. 243, pp. 71–78

Abstract

BACKGROUND: Internal hemipelvectomy is a challenging procedure often complicated by wound healing issues. To guide surgical planning and reduce the risk of wound complications, we developed and validated a preoperative risk-stratification model. STUDY DESIGN: We reviewed clinical, surgical, and pathologic data from 411 patients who underwent en bloc internal hemipelvectomy for malignant pelvic tumors between 1996 and 2018. The sample included a training set (N = 123) from a US tertiary hospital and a validation set (N = 288) from centers in Canada and The Netherlands. Using logistic regression, we identified key predictors of wound complications requiring surgical intervention and developed a risk-scoring system that incorporates Enneking-Dunham resection type and tumor anatomic compartment extension. Patients were stratified into 3 risk categories: low (0 to 8 points), intermediate (9 to 13 points), and high (greater than or equal to 14 points). RESULTS: Wound complications requiring surgery occurred in 34% of the training cohort and 35% of the validation cohort. In the training cohort, rates of wound complications were 7.4%, 40%, and 67% in the low-, intermediate-, and high-risk groups, respectively (p < 0.001); rates were similar in the validation cohort (7.1%, 32%, and 49%; p < 0.001). The risk model demonstrated fair-to-good discriminative performance; the areas under the receiver operating characteristic curves were 0.83 (training cohort) and 0.71 (validation cohort) despite heterogeneity in tumor histology, reconstruction techniques, and perioperative management. CONCLUSIONS: We present the first externally validated prognostic staging system for predicting wound complications after internal hemipelvectomy. The model is simple, reproducible, and clinically applicable, allowing surgeons to preoperatively identify high-risk patients who may benefit from modified surgical approaches or prophylactic soft-tissue reconstruction. Further prospective studies are warranted to optimize management strategies for intermediate- and high-risk patients.

Authors 10

1. Koichi Ogura

   Memorial Sloan Kettering Cancer Center · National Cancer Center Hospital

   Affiliation as printed

   Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan (Ogura)

   From the Orthopaedic Service, Department of Surgery Memorial Sloan Kettering Cancer Center, New York, NY (Ogura, Healey, Boland, Morris)

2. John H. Healey

   Memorial Sloan Kettering Cancer Center

   Affiliation as printed

   From the Orthopaedic Service, Department of Surgery Memorial Sloan Kettering Cancer Center, New York, NY (Ogura, Healey, Boland, Morris)

3. Patrick J. Boland

   Memorial Sloan Kettering Cancer Center

   Affiliation as printed

   From the Orthopaedic Service, Department of Surgery Memorial Sloan Kettering Cancer Center, New York, NY (Ogura, Healey, Boland, Morris)

4. Demiën Broekhuis Aachen Department of Orthopaedic Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands (Broekhuis, Bus, van de Sande)

5. Michaël P. A. Bus Aachen Department of Orthopaedic Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands (Broekhuis, Bus, van de Sande)

6. Peter C. Ferguson

   University of Toronto · Sinai Health System

   Affiliation as printed

   Musculoskeletal Oncology Unit, Sinai Health System, Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada (Ferguson, Griffin, Wunder)

7. Anthony Michael Griffin

   University of Toronto · Sinai Health System

   Affiliation as printed

   Musculoskeletal Oncology Unit, Sinai Health System, Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada (Ferguson, Griffin, Wunder)

8. Michiel A. J. van de Sande Aachen Department of Orthopaedic Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands (Broekhuis, Bus, van de Sande)

9. Jay Steven Wunder

   University of Toronto · Sinai Health System

   Affiliation as printed

   Musculoskeletal Oncology Unit, Sinai Health System, Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada (Ferguson, Griffin, Wunder)

10. Carol D Morris

    Memorial Sloan Kettering Cancer Center

    Affiliation as printed

    From the Orthopaedic Service, Department of Surgery Memorial Sloan Kettering Cancer Center, New York, NY (Ogura, Healey, Boland, Morris)