Orthopedic Surgery and Femoral/Humeral Fracture Repairs

Anesthesia for Hemipelvectomy and Sacrectomy Procedures
  • Matthew John ByarsEmail author
  • Javier D. Lasala
Reference work entry


Hemipelvectomy and sacrectomy are considered long and potentially dangerous orthopedic procedures used for the treatment of soft tissue and bony tumors of the pelvis. The danger is mainly due to the expected significant blood loss during tumor and bone resection. Hemipelvectomies are classed as internal or external, and both share large potential for overall loss of blood. Internal concerns bone resection of the ilium, the periacetabulum, or the pubis. External includes bone resection in the pelvis plus amputation of the affected femur (a high level of amputation). Sacrectomy involves partial or en bloc removal of the sacrum with dissection and ligation of the included neurovascular bundles. It may be included with a hemipelvectomy due to structures affected by the tumor(s). Also included in these cases may be complete or partial removal of organs and viscera such as the bladder, ureters, rectum, perineum, prostate, small or large bowel, vagina, cervix, and uterus. In order to assist with closing the wound left from the sacrectomy, an anterior or posterior rotational skin flap may be utilized (usually anterior).

Soft tissue sarcomas and bone tumors are the primary cancer etiologies requiring these surgeries. Generally, patients will have completed other types of treatment including chemotherapy or radiation prior to a surgeon considering this uncommon and radical procedure. Proper preparation by the anesthesia and surgical teams can reduce hemodynamic instability and provide for adequate analgesia and make the patient’s recovery more successful. Proper anesthetic preparation for these cases is paramount, as the hemodynamic instability due to blood loss is the largest risk to the patient both intraoperatively and postoperatively.


Hemipelvectomy Sacrectomy Pelvic sarcomas Hemipelvectomy anesthesia Sacrectomy anesthesia Amputation 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Anesthesiology, Critical Care and Pain MedicineUTMD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Anesthesiology and Perioperative MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

Section editors and affiliations

  • Garry Brydges
    • 1
  1. 1.Department of Anesthesiology Division of Anesthesia, Critical Care and Pain MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

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