Hemipelvectomy- only a salvage therapy?

Abstract

After the first hemipelvectomy in 1891 significant advances have been made in the fields of preoperative diagnosis, surgical technique and adjuvant treatment in patients with pelvic tumors. The challenging surgical removal of these rare malignant bone or soft tissue tumors accompanied by interdisciplinary therapy is mostly the only chance of cure, but bares the risk of intensive bleeding and infection. The reconstruction after hemipelvectomy is of importance for the later outcome and quality of life for the patient. Here, plastic surgery with microvascular free flaps or local rotational flaps improved the reconstruction and reduced infection rates. Average local recurrence rates of 14% demonstrate good surgical results, but 5 year survival rates of only 50% are described for some tumor entities, showing the importance of a multimodal collaboration. On a basis of a selective literature review the history, indications, treatment options and outcome of hemipelvectomies are presented.

Hemipelvectomy: Outcome in 84 dogs and 16 cats. A veterinary society of surgical oncology retrospective study

“…In people, hemipelvectomy has been used for many years for the resection of neoplasms affecting the upper thigh . Important prognostic features in people include tumor diagnosis and stage, as well as the location, size, and ability of attain a clean resection margin.…”

“…Important prognostic features in people include tumor diagnosis and stage, as well as the location, size, and ability of attain a clean resection margin. Because the tumor is often occult to direct palpation and observation, difficulties similar to those we report are experienced in human patients including delays in the establishment of a definitive diagnosis, high rates of local recurrence because of local extension of tumor into adjacent pelvic structures, microscopic foci of tumor in otherwise normal tissue and widespread invasion into major pelvic veins . These facets of local tumor invasion support the need for careful surgical planning to ensure resection can be accomplished without encroaching into the peritumoral environment.…”

Vaginal delivery after hemipelvectomy and pelvic radiotherapy for chondrosarcoma

“…The first successful hemipelvectomy was performed in 1895 by Girard. The malignant tumours of the bone or soft tissue of pelvis osteosarcoma, chondrosarcoma and Ewing's sarcoma are the most common indications for the procedure 3 Figure 1. schematically illustrates three subtypes of hemipelvic resection approaches 3.…”

“…The malignant tumours of the bone or soft tissue of pelvis osteosarcoma, chondrosarcoma and Ewing's sarcoma are the most common indications for the procedure 3 Figure 1. schematically illustrates three subtypes of hemipelvic resection approaches 3. Type I only includes the ilium, or the ilium and gluteal muscle (type Ia), or the ilium with a portion of the sacrum (type I/S).…”

“…Subtypes of hemipelvectomy depending on resection sites, as presented in Wedemeyer and Kauther 3. Type I: ilium only; type IA: ilium and gluteal muscles; type I/S: ilium with a portion of the sacrum; type II: periacetabular region; type IIA: periacetabular region including the hip joint; type III: parts or complete ischium and pubis.…”