Connective Tissue Oncology Society

2001 CTOS Annual Meeting Posters— Surgery

THE CONCEPT OF A GLUTEAL (BUTTOCK) COMPARTMENT: RADIOPATHOLOGICAL CONSIDERATIONS, INDICATIONS, AND SURGICAL TECHNIQUE OF RESECTION.
James C Wittig¹, Felasfa Wodajo¹, Jacob Bickels², Yehuda Kollender², Kristen L Kellar-Graney¹, Robert M Henshaw², Isaac Meller², Martin M Malawer¹
¹Division of Orthopedic Oncology Washington Cancer Institute Washington Hospital Center, ²National Unit of Orthopedic Oncology Tel-Aviv Sourasky Medical Center

OBJECTIVE: This study reports our guidelines for limb-sparing surgical resection of gluteus maximus tumors in lieu of hemipelvectomy and presents our oncological functional results. The concept of a buttock compartment is presented with its unique pathologic and radiologic considerations.

METHODS: Between 1991 and 2001, 13 patients were treated (7 males, 6 females) with buttock resection. Histology included: liposarcoma (5), leiomyosarcoma (3), MFH (1), fibromatosis (2), and myxoma (2). Median tumor size was 10 cm. SIx patients received adjuvant chemotherapy or radiation. Surgical resection was performed through a curvilinear incision in the shape of a question mark. The sciatic nerve was explored early and frozen section biopsy performed through its fascial sheath. The inferior gluteal vessels and branches of the superior gluteal vessels were ligated at the level of the sciatic notch and the gluteus maximus was resected en bloc.

RESULTS: The follow-up ranged from 2 months to 80 months (mean: 30.5 months). There were no local recurrences. Three patients died of metastatic disease. Pathological analysis demonstrated the sciatic nerve sheath to be free of tumor and the deep fascia of the gluteus maximus to be intact in all patients. All patients were ambulatory without assistance. No patient reported compromise in functional activities. Two patients complained of pain when sitting on hard surfaces for prolonged periods of time. Complications included Skin Flap Necrosis (partial) in 4 patients.

CONCLUSION: Surgical resection of the buttock is a safe and reliable surgical option for treatment of selected soft-tissue tumors arising from the gluteus maximus. Gluteus maximus tumors can grow to large sizes but remain contained within the investing fascia of the muscle, thus facilitating compartmental resection by single myectomy. There is minimal functional loss following resection of the gluteus maximus.