Internal Hemipelvectomies: Resection and Reconstructive Options

Abstract

Pelvic resections are technically difficult and complex procedures. This is because of the anatomy of the pelvic bone, the close proximity of pelvic viscera and vital neurovascular structures, and the usually large size of the tumors themselves. In addition, pelvic surgery often has significant psychological, visceral, and functional effects on the patient. Often referred to as a “heroic surgery,” several authors have questioned whether this “heroic surgery is justifiable.” They have found that despite the challenges faced by both the surgeon and the patient, evenwhen performed by experienced hands, pelvic resections result in high emotional acceptance and functional results, especially given the alternatives. Pelvic resections vary widely in size and shape, depending on the extent, nature, and location of the tumor. There are 2 types of hemipelvectomies; the “classic hemipelvectomy” or external hemipelvectomy (hind quarter amputation), and the limb sparing, internal hemipelvectomy. When considering a hemipelvectomy the questions that arise are, can the limb be salvaged and when is a hind quarter amputation recommended. If a partial pelvic resection does not allow for safe margins about the lesion or if the consequences of extirpation of the lesion are such that the residual limb is essentially functionless, a hind quarter amputation, or an external hemipelvectomy, is recommended. Anatomically speaking, the essential components needed to have a functional leg are the lumbosacral plexus, the femoral neurovascular bundle, and the hip joint. If any 2 of these 3 structures are resected along with the tumor, the resulting limb is useless, thus limb salvage, with internal hemipelvectomy, is not indicated and an external hemipelvectomy (hind quarter amputation) is recommended. However, when the tumor does not encompass these structures, an internal hemipelvectomy should be performed. Despite the difficulty in performing an internal hemipelvectomy or limb salvage, studies have shown that it can provide the patient with better functional results and improved quality