Limb-sparing surgery for primary malignant tumours of the pelvis

Treatment of malignant tumours of the pelvis represents one of the most difficult problems in musculoskeletal oncology. The aim of this paper is to present our results in 16 cases of primary malignant pelvic tumours following resection only or following reconstruction with autogenous or allogenous bone grafts without using megaprostheses, and to assess the possibility to restore acceptable function with autogenous or allogenous bone grafts while avoiding the high risks of massive endoprostheses. Wound complication was the most common complication in our series, with 10 patients requiring additional treatment in the form of local surgical debridement, appropriate multi-drug antimicrobial therapy and wound care. Secondary pelvic reconstruction was performed in two patients with chondrosarcoma, due to local recurrence. External hemipelvectomy was not required in any patient. Morbidity also included the sacrifice of nerve roots in 4 patients. The mean follow-up was 42.4 months (range, 24 to 60). One patient is alive with disease, five patients have died of metastatic disease (2 of them had evidence of local recurrence), and the remaining ten patients are alive with no evidence of disease. Major blood loss and long operation time, aggressive radical surgery due to the frequent delay in diagnosis, and wound complications after surgery are important points that should be considered in the treatment of primary malignant pelvic tumours. Therefore, the management requires meticulous preoperative investigation, a multidisciplinary approach and experienced surgeons.