Background and Goal of study: Hemipelvectomy (external or internal) is a major orthopedic surgical procedure. Primary bone and soft tissue pelvic sarcoma are main indications. Anesthesia and perioperative care may be considered as challenging because of the extensive tissue trauma, significant blood and fluid loss, bleeding disorders and intense postoperative pain. The goal of study was determine the survival rate and demonstrate the anaesthetic and perioperative management. Material and methods: After ethical approval, we conducted a retrospective study of 35 consecutive cases collecting data from medical records and from the Department of Pathology database of all patients submitted to hemipelvectomy in the National Cancer Institute, Brazil, in the period between 2000 and 2013. Results and Discussion: Survival mean time after surgery was 22.1 months. In bivariated analysis, only advanced disease stage was significant as an independent factor for death (p=0,001, HR= 6,0, 95% CI for HR = 2,03 – 17,6). In multivariated analysis at 5% level, only advanced disease stage (levels 3 or 4) was an independent risk factor to reduce survival rate. External hemipelvectomy was performed in 23 (65.7%) patients. Preoperative data: age 44 years (median); weight 69.1 Kg (median); male 68.5%. General anaesthesia plus regional (epidural with opioids mainly) was done in 32 (91.4%) patients. In perioperative period, 23 (65.7%) patients presented hemodynamic instability. All received fluid resuscitation. Vasopressors were required in 12 (34.2%) patients. Six (17.1%) presented bleeding disorders. Median cristalloid infusion was 3500 ml and colloid administration was 500-1500 ml. Twenty (57.1%) patients received red blood cell concentrate and 4 (11.4%) required other blood products in the operating room (OR). Third tree (94.2%) patients had the trachea extubated in the OR. Severe acute pain was present in 31,4% of the cases and even a larger percentage developed chronic pain (40%). Seventeen (48.5%) patients were transfused postoperatively. One (2.8%) patient developed acute renal failure, 2 (5.7%) presented neurological disorders, 1 presented arrhythmias and 9 (25.7%) developed surgical wound complications. Median hospital stay after surgery was 6 days. Conclusion: Despite advances in anaesthesia and surgical management the survival rate after hemipelvectomy remain low and hemodynamic instability, transfusion rate, acute and chronic pain and poor outcomes remain high.

Hemipelvectomy: survival rate, anaesthesia and perioperative management in a serie of 35 cases