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Published on: July 31, 2016
Outcomes of Palliative Hemipelvectomy in Comprehensive Cancer Center Patients with Metastatic Cancer: Retrospective
Roni Rosen1, Amitabh Gulati2, Christan Bartsch1
1From the Departments of Surgery (Rosen, Bartsch, Santos, Nash, Omer, Aysola, Vaynrub), Memorial Sloan Kettering Cancer Center, New York, NY.
Background:
Hemipelvectomy is a complex operation 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.
Study Design:
Retrospective review of 10 patients with stage IV cancer who underwent palliative hemipelvectomy at a comprehensive cancer center.
Results:
Median age of the cohort was 60 years; 7 patients were male. Five patients had previous radiotherapy to the pelvic bone. Hemipelvectomies involved 1 to 2 Enneking-Dunham pelvic zones in 6 patients and 3 to 4 zones in 4 patients. Six patients had Clavien-Dindo complication of grade 3 or higher. Median overall survival was 6.6 months. Surgical complication 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 (1 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 3 (anterior pelvis).
Conclusions:
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 tumor may benefit from palliative hemipelvectomy; for others, less invasive approaches should be considered whenever feasible.
