Definition and Overview
Hemipelvectomy is the surgical removal of half of the pelvis usually for the treatment of localized tumors and, rarely, for cancer that has metastasized to the area.
Half pelvis removal may be classified as external or internal. The former involves the resection of the bones of the pelvis and the amputation of the leg on the same side, which is usually followed up by the fitting of prostheses. The latter, on the other hand, spares the limb but removes the diseased bones and tissues.
Surgical reconstruction is a standard after hemipelvectomy and involves the use of flap procedure or graft technique that recreates the pelvis and protects the remaining structures as well as the attached metal screws and plates from exposure. Reconstruction surgery is also performed to reduce the possibility of a hernia from developing.
Who Should Undergo and Expected Results
Many factors are considered before a half pelvis removal is performed. These include age, type and severity of the disease, actual location of tumors, gender, and possible risks and complications.
When performed for cancer treatment, it is typically recommended to patients with osteosarcomas (bone cancer) specifically Ewing’s sarcoma and chondrosarcoma. It is also ideal if the tumor is localized or contained within the pelvic area, although in some – and rare – cases, the surgeon may perform the procedure on a metastasized tumor.
In scenarios where the patient has already undergone other types of surgeries and treatments related to cancer, hemipelvectomy is explored if the patient has become non-responsive to these therapies or if the localized tumor has become recurrent.
Hemipelvectomy may also be necessary if the pelvis has been severely damaged due to a traumatic injury like a vehicle accident or if the leg on the same side has already lost its function.
The surgery can be used as a treatment for diseases or as part of palliative care, which means it can be performed to extend the patient's quality of life. However, with the pelvis and sometimes the leg removed, the patient may be at risk of developing bone-related deformities such as scoliosis or back pain, which can be controlled or improved with regular physical therapy.
How Does the Procedure Work?
Hemipelvectomy is usually performed by making a large incision either in the perineum, which is near the anus, or ilioinguinal, which is part of the lumbar nerves located at the back of the body. The tumor along with a healthy tissue that serves as a clear margin are then excised and sent to a lab to assess the extent of cancer. Depending on the size, location, and spread of tumors, more bones and tissues may be removed until the tissue come back clean. If necessary, the leg on the same side is also amputated.
The surgeon then proceeds with reconstructing the affected body part usually through an allograft, (tissue from a human donor) or autograft, in which the skin is obtained from the patient’s body which is usually the thigh.
Before the procedure is completed, a Foley catheter is inserted to facilitate the draining of urine while the wound is still healing. The incisions are then sutured properly.
Possible Risks and Complications
Two of the serious risks and complications of the procedure is extensive bleeding and infection due to the proximity of the resected area to the bowel. For this reason, surgeons provide patients with antibiotics during pre-operative care.
Half pelvis removal is one of the rarest procedures performed in the lower extremities, which can pose a challenge for both patients and surgeons. It may be difficult for patients to find surgeons who have the knowledge, expertise, and experience to perform the procedure precisely while surgeons may struggle with all the possible risks and complications.
Apffelstaedt JP, Driscoll DL, Karakousis CP. Partial and complete internal hemipelvectomy: complications and long-term follow-up. J Am Coll Surg. 1995;181:43-48.
Apffelstaedt JP, Zhang PJ, Driscoll DL, Karakousis CP. Various types of hemipelvectomy for soft tissue sarcomas: complications, survival and prognostic factors. Surg Oncol. 1995;4:217–222.