Survival, Local Recurrence, and Function After Pelvic Limb Salvage at 23 to 38 Years of Followup

Background: Malignant pelvic tumors frequently pose challenges to surgeons owing to complex pelvic anatomy and local extension. External hemipelvectomy frequently allows adequate margins but is associated with substantial morbidity and reduced function. Limb salvage is an alternative approach when adequate margins can be achieved, but long-term function and survival are unclear.

Questions/purposes: We therefore determined the long-term survival; development of late local recurrence and metastases; function; and need for further reconstructive procedures for patients undergoing limb salvage for treatment of malignant pelvic tumors.

Patients And Methods: We retrospectively reviewed 60 patients treated with pelvic limb salvage before 1989. We reviewed medical records and sent questionnaires incorporating Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage scores to the 38 patients who had no evidence of disease in 1989; 15 patients responded. Minimum followup was 23 years (median, 30 years; range, 23-38 years).

Results: Overall survival rate of the 60 patients was 45%: 100% Stage IA, 75% Stage IB, 31% Stage IIB, and 0% Stage III were alive. Late local recurrence developed only in patients with chondrosarcoma (three of 24). Two patients developed late distant bone metastases. Function declined: the MSTS score of the 15 patients who completed a questionnaire decreased 23%. Two patients had further reconstructive procedures.

Conclusions: At 23- to 38-year followup, we believe pelvic limb salvage is a reasonable treatment if satisfactory margins can be achieved. If a patient with pelvic sarcoma is free of disease 5 years after sarcoma resection, the subsequent risk of death from sarcoma appears to be low. Late local recurrence remains a risk in patients with pelvic chondrosarcoma. Patient-reported function of the salvaged limb declined with long-term followup.

Level Of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.