Pelvic tumor resection
Resecting tumors of the bony pelvis, focused on sarcomas, is one of the most complex surgeries in the specialty. The goal is to remove the tumor with safe margins while preserving the limb and reconstructing the pelvic ring when needed.
Why it is complex
The pelvis has a difficult three-dimensional anatomy, surrounded by vessels, nerves and organs. Achieving oncologic margins while preserving function demands very precise planning and, often, a multidisciplinary team.
As with any sarcoma, the tract of the previous biopsy is removed en bloc together with the tumor. That is why the biopsy must be planned by the team that will perform the resection, in line with the intended surgical approach: in the pelvis, a poorly placed tract can contaminate neighboring compartments and force a larger resection.
When it is oncologically safe, the limb is preserved (internal hemipelvectomy) instead of amputating.
Not all resections are alike
The need to reconstruct depends on which part of the pelvis is removed. When a zone that does not carry the body's weight is resected —for example part of the iliac wing or the pubic ramus—, reconstruction is often unnecessary and the functional result is very good.
By contrast, when the resection involves the acetabulum (the socket where the hip articulates), the transmission of weight from the spine to the leg is interrupted, and that continuity must be reconstructed to be able to walk again.
3D planning and custom implants
From the CT and MRI, the pelvis is reconstructed in 3D to plan the cuts that leave the tumor with a safe margin, sparing vessels and nerves.
Prostheses designed specifically for each patient's anatomy and defect, from their imaging.
3D-printed templates that rest on the bone in the operating room and carry the plan across exactly, enabling precise cuts according to the intended margin.
Reconstruction and recovery
Depending on the resected area, the pelvic ring may be reconstructed with custom implants, allograft or other techniques that restore the connection between the spine and the limb. Rehabilitation is prolonged and tailored to each case; regaining walking is a process of months.
Risks and considerations
- Major surgery with risks of bleeding, infection and wound-healing problems.
- Injury to nerves of the pelvis or the leg, with weakness or loss of sensation.
- Effects on urinary, bowel or sexual function, depending on how close the tumor lies to the bladder, the rectum and the pelvic nerves; when necessary the surgery is done together with urology, vascular surgery or colorectal surgery.
- A limp, a leg-length difference or the need for a walking aid, depending on the reconstruction.
- Prolonged rehabilitation.
- Local recurrence and risk of metastasis, depending on type and grade. In the pelvis a local recurrence is considerably harder to salvage than in a limb, which is why the margin achieved at the first operation matters so much.
Shared decision-making
The decision to operate is made together: we discuss the diagnosis, the goals of treatment, the expected benefits, the risks and the alternatives. Surgery does not guarantee an outcome; it aims to control the tumor while preserving as much function as possible.
This information is educational and does not replace a medical evaluation. Every case requires an individualized assessment and treatment, and no surgery guarantees an outcome.
Questions about your case?
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