External Hemipelvectomy in Soft Tissue Sarcomas: Are They Still Needed?

Background: The development of new technologies, the interpretation of amputations as therapeutic failures by society, and the high morbidity and mortality associated with external hemipelvectomies make these mutilating surgical procedures appear obsolete. Herein, we review the scientific literature on the topic and present two cases of high-grade ulcerated soft tissue sarcomas in the gluteal region which show exceptional behavior and different outcomes.

Methods: We performed a literature review of the PubMed databases from 2014 to April 2024. Additionally, we present two cases of soft tissue sarcomas in an 18-year-old female patient and in a 71-year-old female patient, which were treated with extended external hemipelvectomies with anterior flap, in combination with an abdominoperineal amputation and a colostomy in one case.

Results: After 4 years of follow-up, case 1 is living a relatively normal life. She had an uncomplicated pregnancy and a cesarean section delivery. Case 2 underwent emergency surgery for intestinal perforation and sepsis. She died 2.5 months following the surgery.

Conclusions: External hemipelvectomy for soft tissue sarcoma treatment is a demanding surgical procedure with purpose in selected cases after review by multidisciplinary committees and with informed patient consent. This should be similarly individualized and extended to other pathologies when possible.