Internal Hemipelvectomy for Primary Pelvic Bone Tumours Surgical Complications and Oncological Outcomes

Abstract

Primary bone tumours of the pelvis usually present late, with large tumour size, in proximity to major neurovascular structures and visceral organs. Due to its operative morbidity, prolonged time of surgery, associated blood loss, and inherent anatomical challenges, internal hemipelvectomy is practiced in specialised centers only. This study was designed to evaluate the surgical complications and oncological outcomes in patients undergoing internal hemipelvectomy for primary pelvic bone tumours. A prospectively collected database at our Institute was retrospectively reviewed, and 51 consecutive patients who underwent internal hemipelvectomy for primary pelvic bone tumours from 2005 to 2020 were identified. Ewing’s sarcoma and chondrosarcoma (17 each) were the most common diagnoses. Neoadjuvant therapy was offered to 27 patients (53%), with a mean tumour response of 57%. Thirty patients received adjuvant radiation to the operative site, and 87% completed the course of chemotherapy.

Negative surgical margins were obtained in 84.4% patients. 22 patients had flap-related complications. Age more than 20 years, T stage, and the number of segments resected adversely impacted flap-related complications. Three patients needed explantation of the prosthesis, and six patients had nerve injuries. After a median follow-up of 44 months (range, 2-148 months), 23 patients had recurrences. The 3-year event-free survival and overall survival were 47% and 61%, respectively, and at 5 years, they were 39% and 59%, respectively. Patient selection plays an essential role and should be based on accurate preoperative imaging, appropriate neoadjuvant therapy, and effective preoperative planning. Surgical expertise supported by aggressive physiotherapy is essential for rehabilitation. Despite the various challenging perioperative hurdles, it is a viable option for limb salvage for pelvic sarcomas.