Complications of PI to PIII hemipelvic resections for intermediate and malignant tumours

Listen to Simon and Amy discuss the paper 'Complications of PI to PIII hemipelvic resections for intermediate and malignant tumours' published in the June 2026 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint from the publishers of Bone & Joint Open. Today, we're discussing the paper, 'Complications of PI to PIII hemipelvic resections for intermediate and malignant tumours,' published in June 2026 by M A Smolle and colleagues. I'm Simon, and I'm joined by my co-host, Amy.

Hello, Simon. I'm looking forward to today's discussion. This paper addresses a significant issue in orthopaedic oncology. The surgical management of intermediate and malignant tumors in the pelvis is known for its complexity.

Indeed. The aim of this research was to systematically review and analyze all reported complications following PI to PIII pelvic resections for intermediate and malignant tumors. Given the surgery's complexity due to their proximity to vital anatomical structures, understanding the complications is essential.

Absolutely, Simon. The authors conducted a systematic literature search on PubMed adhering to PRISMA guidelines and identified [00:01:00] 1,683 study records. They included 90 original studies published up to the 22nd of July 2025, and analyzed data on 2,199 patients with a mean age of 39.3 years.

The most common types of reconstructions were custom-made implants and ice cream cone prosthesis. Infections and wound healing problems were the most common complications, coupled with a significant proportion of patients facing neurovascular complications and deep vein thrombosis.

What's especially interesting is the comparison between different reconstruction types. The study found that biological reconstructions were often associated with higher rates of nerve injuries, construct failures, and secondary implant revision or removal compared to mega-prosthetic reconstructions.

An important point. They also noted lower infection and implant revision or removal rates in studies published after 2015, suggesting that refined treatment approaches and improved implant designs have had a significant positive impact.[00:02:00] 

Another key statistic is the incidence of secondary external hemipelvectomy, which was necessary in over 4% of sacrum-sparing pelvic resections, mostly due to local recurrence. It certainly highlights the complexity and technical demands of these surgeries. The fact that older techniques and less experienced surgeons might have higher complication rates underscores the importance of continual improvement and training in the field.

Indeed, and the pooled rates of different complications provided in the study are quite telling. Infections accounted for 15%, wound healing problems 13%, nerve injuries 7%, and deep vein thrombosis 4%. These figures vividly illustrate the risks involved.

In summary, treating pelvic malignancies remains a significant challenge. These technically demanding resections and complex reconstructions come with many complications. However, ongoing advancements in surgical techniques and implants offer hope for better patient outcomes.

To recap, the most frequent complications following sacrum-sparing pelvic [00:03:00] resections are infections, wound healing problems, and dislocations. Neurovascular issues and deep vein thrombosis are also significant concerns. Though recent improvements indicate a positive trend, the journey towards minimising these risks continues.

Thank you, Amy, and thank you to our listeners for joining us on this in-depth look into a critical topic in orthopaedic oncology. Stay tuned for our next episode as we continue to bring you the latest from Bone & Joint Open. Goodbye, everyone!