Enneking lays out the founding rationale and selection criteria for local resection (limb salvage) as an alternative to hemipelvectomy for malignant tumors of the pelvis and proximal femur. He defines which tumor types and anatomic situations make resection oncologically safe. The paper is drawn from a series of 17 consecutive radical local resections.
This paper is the conceptual groundwork for limb-salvage surgery in orthopedic oncology, written when hemipelvectomy was the default for pelvic sarcoma. The core decision rule still holds: match the operation to tumor biology. Radiosensitive marrow tumors get radiation, and connective-tissue sarcomas need complete excision before metastasis because nothing else cures them.
The biopsy tract lesson is the highest-yield takeaway. A poorly placed or unexcised biopsy contaminates the field and drives local recurrence, which is why the biopsy should be done by the surgeon who will perform the definitive resection and oriented for en-bloc removal.
The anatomic checklist for resectability (tumor within iliopsoas, preserved femoral vessels and nerve, intact bladder and rectum, salvageable innominate bone for stability) is the direct ancestor of modern pelvic resection planning. When the dissection to spare these structures would cut close enough to contaminate, choose hemipelvectomy over an unsafe resection.
Enneking lays out the founding rationale and selection criteria for local resection (limb salvage) as an alternative to hemipelvectomy for malignant tumors of the pelvis and proximal femur. He defines which tumor types and anatomic situations make resection oncologically safe. The paper is drawn from a series of 17 consecutive radical local resections.
This paper is the conceptual groundwork for limb-salvage surgery in orthopedic oncology, written when hemipelvectomy was the default for pelvic sarcoma. The core decision rule still holds: match the operation to tumor biology. Radiosensitive marrow tumors get radiation, and connective-tissue sarcomas need complete excision before metastasis because nothing else cures them.
The biopsy tract lesson is the highest-yield takeaway. A poorly placed or unexcised biopsy contaminates the field and drives local recurrence, which is why the biopsy should be done by the surgeon who will perform the definitive resection and oriented for en-bloc removal.
The anatomic checklist for resectability (tumor within iliopsoas, preserved femoral vessels and nerve, intact bladder and rectum, salvageable innominate bone for stability) is the direct ancestor of modern pelvic resection planning. When the dissection to spare these structures would cut close enough to contaminate, choose hemipelvectomy over an unsafe resection.