Pelvic resections in primary sarcomas : Surgical outcomes and survival analysis of 75 patients

This study aims to compare the complication rate, local recurrence and survival of different types of pelvic resections. Special interest is to compare the results from external and internal hemipelvectomies if the iliac wing resections are separately evaluated, as they are usually easier to operate and do not need any reconstruction, therefore they might disfigure the results from internal hemipelvectomy in positive direction, if involved in the same group.

This non-randomized retrospective study included 75 cases with a mean follow-up time of 6.9 years. We divided them to three groups according to the type of surgery (external and internal hemipelvectomy, iliac wing resection). The oncological stages, surgical margins, local recurrences, complications and the survival rates were recorded for statistical analyses.

A wide surgical margin (R0) was achieved in 73.3% after external hemipelvectomy, 47.6% after internal hemipelvectomy and 77.8% after iliac wing resection. We did not find significant differences in rates of local recurrence between the groups: the lowest was recorded after external hemipelvectomy (26.7%) and there was no difference between internal hemipelvectomy and iliac wing resection (33.3%). The 5‑year survival was 26.7% in external hemipelvectomy, 35.7% in internal hemipelvectomy and 61.1% for iliac wing resection. Cox regression analysis identified negative prognostic factors for survival as histological grade, local recurrence and patient's age but not the type of surgery.

Internal hemipelvectomy is as safe a procedure as the external hemipelvectomy concerning 5‑year survival, complications and local recurrence, even if iliac wing resections are excluded from this group.