Hemipelvectomy: Report of 12 cases, review of the literature, and therapeutic implications

Abstract

Between 1988 and 1995, hemipelvectomy was performed in 12 patients with malignant neoplasms; there were three standard, five conservative, and four extended hemipelvectomies. At the time of the operation, two patients had inguinal lymph node metastases of an epitheloid sarcoma and three patients had pulmonary metastases. Three of seven patients showing no metastases at the time of operation, and both patients with lymph node metastases, have been continuously free of disease at a mean follow-up of 53 months (range, 23-85 months). The three patients with primary pulmonary metastases, and four patients who developed distant metastases after the operation, died after an average time of 20 months (range, 8-35 months). In three patients (two with extended hemipelvectomies, one with standard hemipelvectomy) there was necrosis of the dorsal skin flap, and in one patient with conservative hemipelvectomy, a deep infection developed, without necrosis of the skin flap. The quality of rehabilitation was more influenced by the individual attitude of the patient than by the extent of the surgical procedure, and it was excellent in four patients, good in five patients, and poor in three patients. Despite the increasing number of limb-salvage procedures indicated, hemipelvectomy continues to be an important and useful surgical procedure in musculoskeletal tumor surgery in selected patients with malignant pelvic tumors.