Hemipelvectomy for soft tissue sarcoma: clinical results in fifty-three patients

The management of high-grade extremity sarcomas typically combines local surgical excision with some form of adjuvant therapy. However, some patients with large proximal lesions present with no local resection options, and high radical amputation is often the only way to accomplish complete tumour excision. A retrospective review was made of the clinical courses of 53 patients with high-grade sarcomas of the lower extremity who underwent hemipelvectomy with curative intent at the National Institutes of Health between 1975 and 1989. Hemipelvectomy provided excellent local control, with no local recurrences. Although 60% of the patients experienced post-operative complications, the operative mortality was zero. Ten years after hemipelvectomy, the actuarial disease-free rate was 25% and the survival rate was 35%. There were no statistically significant survival differences when patients were stratified according to tumour size, perioperative blood transfusion requirements or the use of adjuvant chemotherapy. We conclude that hemipelvectomy provides excellent local control and a reasonable cure rate for patients with locally unresectable soft tissue sarcomas of the lower extremity.