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.
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American Society of Anesthesiologists. Massive Transfusion Protocol (MTP) for hemorrhagic shock. (n.d.). http://www.asahq.org/.../MTPforASATransfusionCommitteeFinal/en/1. Accessed 14 Aug 2016.Google Scholar
Apffelstaedt JP, Zhang PJ, Driscoll DL, et al. Various types of hemipelvectomy for soft tissue sarcomas: complications, survival and prognostic factors. Surg Oncol. 1995;4(4):217–22.CrossRefGoogle Scholar
Baliski CR, Schachar NS, McKinnon JG, et al. Hemipelvectomy: a changing perspective for a rare procedure. Can J Surg. 2004;47(2):99–103.PubMedPubMedCentralGoogle Scholar
Beck LA, Einertson MJ, Winemiller MH, et al. Functional outcomes and quality of life after tumor-related hemipelvectomy. Phys Ther. 2008;88(8):916–27.CrossRefGoogle Scholar
Biermann JS, Adkins D, Benjamin R, et al. Bone cancer: clinical practice guidelines in oncology™. J Natl Compr Cancer Netw. 2007;5(4):420–37.CrossRefGoogle Scholar
Freeman AK, Thorne CJ, Gaston CL, et al. Hypotensive epidural anesthesia reduces blood loss in pelvic and sacral bone tumor resections. Clin Orthop Relat Res. 2016;475(3):634–40.CrossRefGoogle Scholar
Ham JS, Koops HS, Veth RPH, et al. External and internal hemipelvectomy for sarcomas of the pelvic girdle: consequences of limb-salvage treatment. Eur J Surg Oncol. 1997;23(6):540–6.CrossRefGoogle Scholar