Outcomes of Palliative Hemipelvectomy in Comprehensive Cancer Center Patients with Metastatic Cancer: Retrospective Study.

Abstract

Hemipelvectomy is a complex surgery that is usually performed with curative intent. It is rarely performed for palliation in patients with advanced cancer, and its efficacy in achieving palliation is unknown. Retrospective review of 10 patients with stage IV cancer who underwent palliative hemipelvectomy at a comprehensive cancer center. Median age of the cohort was 60 years; 7 patients were male. Five patients had prior radiotherapy to the pelvic bone. Hemipelvectomies involved 1-2 Enneking-Dunham pelvic zones in 6 patients and 3-4 zones in 4 patients. Six patients had Clavien-Dindo complications of grade 3 or higher. Median overall survival was 6.6 months. Surgical complications resulted in death in 3 patients. At their 3-month follow-up, 5 of 8 living patients had increased narcotic requirements, and 4 of 7 with data had reduced pain (one of whom was using high-dose intravenous narcotics). No patients experienced functional improvement, and at 6 months 4 of the 5 who had been ambulatory preoperatively were less mobile. Outcomes tended to be better among patients whose resections were less extensive or limited to zone III (anterior pelvis). Palliative-intent hemipelvectomy provided palliation in a minority of patients, did not improve function, and had high morbidity and mortality. Patients with small anterior pelvic tumors may benefit from palliative hemipelvectomy; for others, less invasive approaches should be considered whenever feasible.