Surgery for primary bone sarcomas of the pelvis.

Primary bone sarcomas of the pelvis represent the most challenging problem in limb-saving surgery. Chondrosarcoma is the most common type, followed by osteosarcoma and Ewing's sarcoma. The symptoms are often vague, so that the diagnosis is made late, when the tumor has already reached a large size. Nowadays hindquarter amputation is reserved for complex tumors involving the sacrum, the sciatic nerve, the iliac vessels or the bladder. Internal hemipelvectomy should be undertaken whenever possible; the reconstructive techniques are based on the three anatomic regions concerned: ilium, periacetabular area, and pubis. Complications occur in more than 50% of the patients. The 5-year survival rate is about 55%. Special scores, such as the MSTS/ISOLS and the TESS score, should be used to make the various studies comparable.