High Yield Overview

HEMIPELVECTOMY - PELVIC TUMOUR RESECTION

Internal (Limb-Sparing) vs External (Hindquarter Amputation) | Enneking-Dunham Classification | Vascular Control | Reconstruction

70-85%5-year survival pelvic sarcoma (localised)

30-50%Major complication rate

15-25%Local recurrence rate (wide margins)

60-70%Limb salvage rate for pelvic tumours

HEMIPELVECTOMY TYPES

Internal Hemipelvectomy

PatternResection of pelvic bone with limb preservation

TreatmentReconstruction vs arthrodesis vs excision arthroplasty

External Hemipelvectomy

PatternHindquarter amputation - complete limb removal

TreatmentPosterior or anterior flap closure

Extended Hemipelvectomy

PatternIncludes sacral or contralateral pubic resection

TreatmentOften requires lumbopelvic fixation

Critical Must-Knows

Enneking-Dunham classification defines pelvic resection zones (I-IV) - essential for surgical planning
Internal hemipelvectomy is limb-sparing; external (hindquarter) involves complete limb removal
Vascular control of common iliac vessels is critical before resection
Sciatic nerve sacrifice often required for posterior tumours - counsel patient preoperatively
Reconstruction options include endoprosthesis, allograft, saddle prosthesis, or no reconstruction

Examiner's Pearls

"
Type I resection (iliac wing) often requires no formal reconstruction
"
Type II resection (periacetabular) is most challenging - requires acetabular reconstruction
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Posterior flap (gluteal) is preferred for external hemipelvectomy coverage
"
Mortality rate 1-5% - major blood loss is the primary intraoperative risk

Clinical Imaging

Imaging Gallery

hemipelvectomy-hindquarter imaging 1 — Clinical imaging for hemipelvectomy-hindquarterCredit: Reddy SS et al. via World J Surg Oncol via Open-i (NIH) (CC-BY)

hemipelvectomy-hindquarter imaging 2 — Clinical imaging for hemipelvectomy-hindquarterCredit: Reddy SS et al. via World J Surg Oncol via Open-i (NIH) (CC-BY)

hemipelvectomy-hindquarter imaging 3 — Clinical imaging for hemipelvectomy-hindquarterCredit: Reddy SS et al. via World J Surg Oncol via Open-i (NIH) (CC-BY)

hemipelvectomy-hindquarter imaging 4 — Clinical imaging for hemipelvectomy-hindquarterCredit: PMC5289170 via Open-i (NIH) via Open-i (NIH) (CC-BY)

Critical Hemipelvectomy Exam Points

Enneking-Dunham Classification

Type I = Iliac wing (above acetabulum). Type II = Periacetabular (most complex). Type III = Pubic rami/ischium. Type IV = Sacral ala. Know the zones and their reconstruction implications.

Vascular Control

Common iliac vessels must be controlled early in the procedure. Internal iliac artery is typically ligated. External iliac vessels are preserved in internal hemipelvectomy. Massive blood loss (5-15 units) is expected.

Nerve Considerations

Sciatic nerve sacrifice is often required for posterior tumours. Femoral nerve must be identified and protected anteriorly. Lumbosacral plexus involvement may preclude limb salvage.

Reconstruction Options

Type I: Often no reconstruction needed. Type II: Saddle prosthesis, allograft-prosthetic composite, or custom endoprosthesis. Type III: May not require reconstruction. Flail hip (excision arthroplasty) is an alternative.

Internal vs External Hemipelvectomy - Decision Guide

Feature	Internal Hemipelvectomy	External Hemipelvectomy
Definition	Pelvic bone resection with limb preservation	Complete hindquarter amputation
Primary Indication	Bone tumour without neurovascular bundle involvement	Tumour involving sciatic nerve or major vessels
Neurovascular Status	Preserved external iliac vessels and femoral nerve	Vessels and nerves sacrificed with specimen
Functional Outcome	Ambulatory with or without aids depending on reconstruction	Wheelchair or prosthetic (limited use)
Reconstruction	Required for Type II (acetabular) resections	Flap coverage for wound closure
Mortality Risk	1-3%	3-5%
Major Complications	30-50% (infection, flap necrosis, dislocation)	20-40% (wound complications, phantom pain)

Mnemonic

PELVIS - Pelvic Resection Zones (Enneking-Dunham)

Posterior ilium (Type I)

Iliac wing resection - above acetabulum, often no reconstruction needed

Periacetabular (Type II)

Acetabular resection - most complex, requires reconstruction

Pubic/ischial (Type III)

Anterior pelvic ring - pubic rami and ischium, minimal disability

Para-sacral (Type IV)

Sacral ala resection - may extend to sacroiliac joint

Memory Hook:P1-P4: Posterior ilium, Periacetabular, Pubic, Para-sacral - following the pelvic ring from back to front

Mnemonic

FLAPS - External Hemipelvectomy Coverage

Posterior (Gluteal) Flap

Preferred flap - based on gluteal vessels, excellent bulk for sitting

Lateral position for surgery

Patient positioning allows access to both anterior and posterior pelvis

Anterior (Quadriceps) Flap

Alternative when posterior tissues involved by tumour

Primary closure goal

Tension-free closure essential to prevent dehiscence

Sitting surface padding

Adequate soft tissue bulk for weight-bearing on remaining pelvis

Memory Hook:FLAPS for coverage - posterior Gluteal flap is the workhorse for hindquarter amputation

Mnemonic

RECON - Type II Reconstruction Options

Resection arthroplasty (flail hip)

No formal reconstruction - femur suspended by soft tissues

Endoprosthesis (custom)

Custom pelvic endoprosthesis or modular system

Composite (APC)

Allograft-prosthetic composite - hemipelvis allograft with THR

Osteosynthesis (arthrodesis)

Iliofemoral or ischiofemoral fusion

No reconstruction (selected)

For elderly or low-demand patients, limb shortening accepted

Memory Hook:RECON for Type II periacetabular defects - multiple options from no reconstruction to custom prosthesis

Overview and Epidemiology

Definition

Hemipelvectomy refers to surgical resection of part or all of one hemipelvis, performed primarily for malignant bone and soft tissue tumours. The procedure is classified as:

Internal hemipelvectomy: Resection of pelvic bone with preservation of the ipsilateral lower limb (limb-sparing surgery)
External hemipelvectomy: Complete amputation through the hemipelvis, removing the entire lower extremity (hindquarter amputation)

Epidemiology

Pelvic Tumours Requiring Hemipelvectomy:

Primary bone sarcomas: Chondrosarcoma (most common), osteosarcoma, Ewing sarcoma
Soft tissue sarcomas extending to bone
Metastatic disease (rarely, for isolated metastasis with curative intent)
Aggressive benign tumours: Giant cell tumour, chordoma

Patient Demographics:

Bimodal age distribution: adolescents/young adults (Ewing, osteosarcoma) and older adults (chondrosarcoma)
Slight male predominance
Pelvis accounts for 10-15% of primary bone sarcomas

Historical Context

First hindquarter amputation: Billroth (1891)
Development of limb-sparing techniques: 1970s-1980s with advances in chemotherapy and imaging
Current limb salvage rate: 60-70% for pelvic tumours at specialised centres

Surgical Anatomy

Pelvic Zones (Enneking-Dunham Classification)

The Enneking-Dunham classification divides the pelvis into anatomical zones for surgical planning:

Type I - Iliac Wing Resection

Anatomical Boundaries:

Iliac wing above the acetabulum
From iliac crest to sciatic notch
Does NOT include acetabulum

Key Structures:

Gluteal muscles (detached)
Iliac vessels (preserved, retracted)
Sciatic nerve (usually preserved unless tumour extends posteriorly)

Reconstruction:

Often NO formal reconstruction required
Soft tissue repair of abdominal wall to remaining pelvis
Excellent functional outcome as hip joint preserved

Functional Outcome:

Near-normal gait
Full weight-bearing on preserved hip
Minimal long-term disability

Critical Vascular Anatomy

Arterial Supply:

Common iliac artery bifurcates into external and internal iliac
Internal iliac artery supplies pelvic viscera and gluteal region - often ligated
External iliac artery continues as femoral artery - MUST be preserved for limb salvage

Venous Drainage:

Presacral venous plexus - major source of intraoperative bleeding
Internal iliac veins - can be ligated
External iliac vein - must be preserved

Collateral Circulation:

Lumbar arteries provide collateral to gluteal region
Inferior epigastric provides pelvic wall collateral
Profunda femoris provides thigh collateral

Indications and Contraindications

Indications for Hemipelvectomy

Internal Hemipelvectomy (Limb-Sparing):

Primary bone sarcoma without neurovascular bundle involvement
Adequate surgical margins achievable (greater than 1cm or good response to chemotherapy)
Preserved external iliac vessels
Functional femoral and/or sciatic nerve

External Hemipelvectomy (Hindquarter Amputation):

Tumour involving major neurovascular bundle (sciatic nerve, external iliac vessels)
Extensive soft tissue involvement precluding limb salvage
Failed limb salvage with local recurrence
Severe pathological fracture with contaminated field
Infected tumour or uncontrolled sepsis

Contraindications

Absolute Contraindications:

Unresectable tumour (sacral body involvement, bilateral pelvic disease)
Distant metastatic disease (except for palliation)
Medical unfitness for major surgery
Patient refusal after informed consent

Relative Contraindications:

Contralateral limb dysfunction (amputation would leave patient non-ambulatory)
Advanced age with significant comorbidities
Poor response to neoadjuvant chemotherapy (for osteosarcoma/Ewing)
Tumour crossing sacroiliac joint extensively

Tumour-Specific Considerations

Chondrosarcoma

Key Features:

Most common primary pelvic bone sarcoma
Chemotherapy and radiation resistant
Wide surgical margins essential

Surgical Principles:

Aim for wide margins (greater than 1cm)
Dedifferentiated chondrosarcoma has worse prognosis
No role for adjuvant chemotherapy (except dedifferentiated)

Prognosis:

Grade I: 90% 5-year survival
Grade II: 70% 5-year survival
Grade III: 30% 5-year survival

Preoperative Assessment

Imaging

MRI (Essential)

Sequence Protocol:

T1-weighted: Bone marrow extent, fat planes
T2/STIR: Tumour extent, oedema
Post-gadolinium: Vascularity, viable tumour
MRA: Relationship to major vessels

Key Assessment:

Tumour extent in bone and soft tissue
Relationship to neurovascular bundle
Skip lesions (additional foci)
Joint involvement

Surgical Planning:

Define resection margins
Assess neurovascular involvement
Plan reconstruction approach
3D reformats for custom prosthesis design

MRI is mandatory for surgical planning - defines tumour extent and resectability.

Biopsy

Core Needle Biopsy:

CT or ultrasound-guided
Multiple cores for adequate tissue
Place biopsy tract to allow excision with specimen

Open Biopsy (if needed):

Longitudinal incision in line with definitive surgery
Meticulous haemostasis
Close in layers without drain if possible

Biopsy Principles:

Discuss with operating surgeon BEFORE biopsy
Biopsy tract must be excised en bloc with tumour
Avoid contaminating neurovascular structures
Send tissue for histology, cytogenetics, and microbiology

Staging Workup

Complete Staging:

Chest CT (pulmonary metastases)
PET-CT or bone scan
Bloods: FBC, UEC, LFT, LDH, ALP
Consider bone marrow biopsy (Ewing sarcoma)

Multidisciplinary Team:

Orthopaedic oncologist
Medical oncologist
Radiation oncologist
Radiologist
Pathologist
Reconstructive surgeon (plastic/vascular)

Surgical Technique - Internal Hemipelvectomy

Preoperative Preparation

Preoperative Planning:

MDT Discussion:
- Confirm diagnosis and staging
- Neoadjuvant therapy completion
- Surgical plan and reconstruction
Imaging Review:
- Define resection margins on MRI
- CT angiography for vascular planning
- 3D reconstruction for custom prosthesis
Patient Preparation:
- Medical optimisation
- Blood products arranged (6-10 units RBC minimum)
- Cell saver available
- ICU bed confirmed
Equipment:
- Tumour resection instruments
- Reconstruction implants (backup options)
- Vascular instruments available
- Nerve stimulator

Surgical Steps by Resection Type

Type I Iliac Wing Resection

Step 1: Anterior Approach

Ilioinguinal or modified iliofemoral incision
Identify and protect external iliac vessels
Identify and protect femoral nerve
Expose iliac crest and anterior ilium

Step 2: Posterior Exposure

Extend incision or separate posterior approach
Detach gluteal muscles from iliac crest
Identify sciatic notch and sciatic nerve
Control superior gluteal vessels

Step 3: Osteotomies

Superior: Along iliac crest (or through crest for narrow margins)
Inferior: Above acetabular dome (confirm with image intensifier)
Posterior: Through sciatic notch, protecting sciatic nerve
Anterior: Through ASIS or anterior ilium

Step 4: Specimen Removal

Remove specimen en bloc
Check margins grossly and with frozen section
Haemostasis of bony surfaces

Step 5: Closure

Reattach abdominal wall to remaining pelvis
Layered closure
Drain to surgical bed

Reconstruction Options for Type II Defects

Saddle Prosthesis

Concept:

Saddle-shaped femoral component
Articulates with cut surface of remaining ilium
No formal acetabular reconstruction

Indications:

Type II resection with preserved iliac wing
Adequate remaining ilium for support
Patient with good bone quality

Technique:

Prepare remaining ilium surface
Insert femoral component (cemented or uncemented)
Saddle rests on iliac surface
Capsular repair for stability

Outcomes:

Ambulatory with walking aids
Significant leg length discrepancy
High revision rate (mechanical failure)
Simple salvage if failure

Surgical Technique - External Hemipelvectomy

Indications for Hindquarter Amputation

Primary Indications:

Tumour involving sciatic nerve and/or external iliac vessels
Extensive soft tissue sarcoma precluding limb salvage
Failed internal hemipelvectomy with recurrence
Uncontrolled infection with tumour

Surgical Technique

Posterior (Gluteal) Flap Technique

Preferred Technique - provides excellent coverage

Step 1: Anterior Dissection

Extended inguinal/ilioinguinal incision
Ligate femoral vessels at inguinal ligament
Divide femoral nerve
Divide adductor muscles at origin
Transect pubic symphysis or pubic ramus

Step 2: Posterior Dissection

Posterior incision from PSIS to ischial tuberosity
Preserve gluteal muscles on posterior flap
Divide sciatic nerve high in pelvis
Control gluteal vessels (maintain flap perfusion via inferior gluteal)

Step 3: Pelvic Division

Sacroiliac joint disarticulation OR
Osteotomy through sacral ala
Divide sacrospinous and sacrotuberous ligaments
Remove specimen en bloc

Step 4: Flap Closure

Rotate posterior flap anteriorly
Trim excess tissue for contour
Tension-free closure
Suction drains

Advantages:

Excellent soft tissue bulk for sitting
Reliable blood supply (inferior gluteal)
Good wound healing

Postoperative Care - External Hemipelvectomy

Immediate:

ICU admission (24-48 hours minimum)
Fluid resuscitation and transfusion
Pain management (epidural or PCA)
Wound monitoring

Wound Care:

Drains removed when output minimal
Monitor flap viability
Early identification of wound complications
May require negative pressure wound therapy

Rehabilitation:

Early mobilisation when stable
Wheelchair initially
Prosthetic assessment (only 20-30% use prosthesis long-term)
Psychological support essential

Complications

Intraoperative Complications

Haemorrhage:

Expected blood loss: 3-10 litres
Cell saver essential
Vascular surgery backup
Risk of presacral venous plexus injury
Management: Direct pressure, packing, vascular control

Nerve Injury:

Sciatic nerve (may be intentional sacrifice)
Femoral nerve (must preserve for internal)
Lumbosacral plexus injury
Obturator nerve

Visceral Injury:

Ureter injury (preoperative stents may help)
Bladder injury
Rectal injury (especially posterior tumours)
Requires intraoperative repair

Early Postoperative Complications

Wound Complications:

Infection: 15-30%
Dehiscence: 10-20%
Flap necrosis: 5-15%
Seroma/haematoma

Venous Thromboembolism:

High risk (10-30% DVT)
Pulmonary embolism risk
Extended prophylaxis required (4-6 weeks)
IVC filter consideration for high-risk

Systemic:

Respiratory complications
Renal failure (blood loss, contrast, myoglobin)
Sepsis
Mortality: 1-5%

Late Complications

Local Recurrence:

15-25% with wide margins
Higher with positive/close margins
Salvage options limited

Reconstruction-Related:

Prosthetic dislocation: 10-30%
Prosthetic loosening
Prosthetic infection: 10-20%
Allograft nonunion/fracture

Functional:

Chronic pain
Phantom limb pain (external hemipelvectomy)
Limb length discrepancy
Gait abnormality

Evidence Base

Internal Hemipelvectomy Outcomes

Key Findings:

51 patients with internal hemipelvectomy for primary bone sarcoma
Local recurrence rate 15% at 5 years
5-year overall survival 62%
Major complication rate 47%
Functional outcome MSTS score 67%

Clinical Implication: Internal hemipelvectomy provides reasonable oncological and functional outcomes but with high complication rate

Periacetabular Reconstruction Comparison

Key Findings:

Compared saddle prosthesis, custom prosthesis, and allograft reconstruction
Overall complication rate 50-60% across all methods
Custom prosthesis had highest functional scores
Flail hip had lowest complication rate but worst function
No single reconstruction method clearly superior

Clinical Implication: Reconstruction choice should be individualised based on patient factors, tumour extent, and surgeon experience

External Hemipelvectomy Functional Outcomes

Key Findings:

62 patients underwent hindquarter amputation
5-year survival 45% for primary sarcoma
Only 25% used prosthesis long-term
Most patients wheelchair-dependent but independent
Quality of life acceptable in survivors

Clinical Implication: Hindquarter amputation provides oncological control with acceptable quality of life when limb salvage not possible

Enneking Classification and Prognosis

Key Findings:

Defined pelvic resection zones I-IV
Type II (periacetabular) most complex with highest morbidity
Zone-based approach allows standardised communication
Prognosis relates to tumour grade and margins, not zone
Classification remains standard for surgical planning

Clinical Implication: Enneking-Dunham classification is essential for surgical planning and communication in pelvic tumour surgery

Wound Complications in Pelvic Sarcoma Surgery

Key Findings:

Wound complications in 45% of pelvic sarcoma resections
Prior radiation increases wound complication risk 3-fold
Posterior flap coverage reduces wound problems in hindquarter amputation
Early debridement and VAC therapy improve outcomes
MDT approach with plastic surgery reduces complications

Clinical Implication: Wound complications are common after pelvic tumour surgery - plastic surgery involvement and meticulous technique essential

Exam Viva Scenarios

Practice these scenarios to excel in your viva examination

VIVA SCENARIOStandard

EXAMINER

"A 45-year-old presents with a 6-month history of left hip pain. Imaging shows a destructive lesion of the left iliac wing extending to the acetabular dome. Biopsy confirms Grade II chondrosarcoma. How would you manage this patient?"

EXCEPTIONAL ANSWER

This is a primary pelvic chondrosarcoma requiring surgical resection. I would complete staging with chest CT and PET-CT. Given Grade II chondrosarcoma is chemotherapy-resistant, treatment is surgical. This appears to be a Type I-II resection (iliac wing with acetabular extension). I would plan internal hemipelvectomy with periacetabular reconstruction using either a saddle prosthesis or custom endoprosthesis. Key considerations include preoperative vascular imaging, blood product availability, and multidisciplinary planning. I would consent for potential external hemipelvectomy if intraoperative findings preclude limb salvage.

KEY POINTS TO SCORE

Chondrosarcoma is chemotherapy and radiation resistant - surgery is primary treatment

Complete staging before surgery (chest CT, PET-CT)

Enneking-Dunham classification guides resection extent

Type II resection requires acetabular reconstruction

Counsel for potential amputation if limb salvage not achievable

COMMON TRAPS

✗Recommending chemotherapy for chondrosarcoma (not effective except dedifferentiated)

✗Failing to stage before surgery

✗Not having backup plan for amputation

✗Underestimating blood loss and complication risks

LIKELY FOLLOW-UPS

"What reconstruction options exist for Type II defects?"

"What are the contraindications to limb salvage?"

"How would your approach differ for osteosarcoma vs chondrosarcoma?"

VIVA SCENARIOChallenging

EXAMINER

"Describe the surgical approach for a Type II internal hemipelvectomy. What are the key steps for vascular control?"

EXCEPTIONAL ANSWER

For Type II periacetabular resection, I use an extended iliofemoral approach with the patient in a floating lateral position allowing anterior and posterior access. Vascular control begins with retroperitoneal exposure of the common iliac vessels. I identify and protect the external iliac artery and vein with vessel loops, and typically ligate the internal iliac artery as its branches supply the specimen. The ureter is identified and protected. Anteriorly, I expose the pubic symphysis and protect the femoral nerve. Posteriorly, I detach the gluteal muscles and identify the sciatic nerve, which I preserve if not involved by tumour. Osteotomies are performed with oscillating saw and osteotomes under image guidance. After specimen removal, I check margins with frozen section before reconstruction.

KEY POINTS TO SCORE

Extended iliofemoral approach with floating position

Early control of common iliac vessels retroperitoneally

Internal iliac artery typically ligated

External iliac vessels and ureter protected

Sciatic and femoral nerve identification critical

Frozen section margin assessment essential

COMMON TRAPS

✗Not controlling vessels before mobilising tumour

✗Forgetting to protect the ureter

✗Not checking margins before reconstruction

✗Inadequate exposure leading to poor visualisation

LIKELY FOLLOW-UPS

"What if frozen section shows positive margins?"

"How do you manage unexpected vascular injury?"

"What is your threshold for converting to amputation?"

VIVA SCENARIOCritical

EXAMINER

"A patient is undergoing internal hemipelvectomy. Intraoperatively, you find the tumour is encasing the external iliac vessels. What are your options?"

EXCEPTIONAL ANSWER

This is a critical decision point. If the external iliac vessels are encased by tumour, limb salvage may not be possible with clear margins. My options are: 1) Convert to external hemipelvectomy if vessels cannot be preserved - this provides definitive oncological treatment but sacrifices the limb. 2) Vascular reconstruction with interposition graft if the involved segment is short and proximal/distal vessels are healthy. 3) If marginal resection would achieve acceptable margins (for low-grade tumours), consider en bloc vessel resection with reconstruction. I would have the vascular surgery team scrub in immediately. The decision depends on tumour grade, patient factors, and vessel reconstruction feasibility. For high-grade sarcoma, I would lean toward amputation rather than risk positive vascular margins.

KEY POINTS TO SCORE

Vascular encasement may preclude limb salvage

Options: amputation, vascular reconstruction, marginal resection

Vascular surgery involvement essential

High-grade tumours favour amputation over compromised margins

Patient should have been consented for this scenario

COMMON TRAPS

✗Attempting to shell tumour off vessels (margin contamination)

✗Not having vascular backup available

✗Prioritising limb salvage over oncological margins in high-grade tumours

✗Not having preoperative consent for amputation

LIKELY FOLLOW-UPS

"What vascular conduits can be used for reconstruction?"

"What are the survival implications of positive margins?"

"How do you counsel a patient preoperatively about this scenario?"

MCQ Practice Points

Enneking-Dunham Classification

Q: What does Type II resection in the Enneking-Dunham pelvic classification involve? A: Periacetabular resection - removal of the acetabulum and surrounding bone. This is the most complex resection type and requires formal hip reconstruction (saddle prosthesis, custom prosthesis, APC) or acceptance of flail hip.

Internal vs External Hemipelvectomy

Q: What is the key difference between internal and external hemipelvectomy? A: Internal hemipelvectomy is limb-sparing - pelvic bone is resected but the lower extremity is preserved. External hemipelvectomy (hindquarter amputation) removes the entire lower limb through the pelvis. The key determinant is neurovascular bundle involvement.

Vascular Control

Q: Which vessel is typically ligated during internal hemipelvectomy? A: The internal iliac artery is typically ligated as its branches supply the resected specimen. The external iliac artery must be preserved to maintain limb perfusion. Early vascular control is essential before tumour mobilisation.

Flap Selection

Q: What is the preferred flap for wound coverage in external hemipelvectomy? A: The posterior (gluteal) flap is preferred as it provides excellent soft tissue bulk for the sitting surface and has reliable blood supply from the inferior gluteal artery. The anterior flap is used when posterior tissues are involved by tumour.

Chondrosarcoma Treatment

Q: Why is surgical resection the primary treatment for pelvic chondrosarcoma? A: Chondrosarcoma is resistant to chemotherapy and radiation therapy. Wide surgical margins are the only treatment proven to achieve local control and cure. This distinguishes it from osteosarcoma and Ewing sarcoma, which respond to neoadjuvant chemotherapy.

Australian Context

Australian Practice

Sarcoma Referral Pathways:

Pelvic sarcomas requiring hemipelvectomy should be managed at designated sarcoma centres with multidisciplinary expertise:

Major Centres:

Peter MacCallum Cancer Centre (Melbourne)
Royal Prince Alfred Hospital (Sydney)
Princess Alexandra Hospital (Brisbane)
Royal Adelaide Hospital
Sir Charles Gairdner Hospital (Perth)

Referral Principles:

Biopsy should ideally be performed at the treating centre
If biopsy performed locally, discuss technique with sarcoma unit first
Complete staging before referral
Urgent referral for suspected primary bone sarcoma

Tumour Boards:

All pelvic sarcomas discussed at sarcoma MDT
Include orthopaedic oncologist, medical oncologist, radiation oncologist, radiologist, pathologist
Surgical planning, neoadjuvant therapy, reconstruction discussed

Centralised Care

Pelvic sarcoma requiring hemipelvectomy should be managed at designated sarcoma centres with MDT expertise for optimal outcomes.

PBS Medications

Neoadjuvant chemotherapy agents (doxorubicin, cisplatin, methotrexate, ifosfamide) are PBS-listed for bone sarcomas through oncology programs.