Major pelvic cancer surgery carries high complication rates, study finds
A systematic review of nearly 2,200 patients reveals that operations removing large pelvic tumors result in infections, wound problems, and blood clots in roughly 13-15% of cases each. The findings could reshape how hospitals prepare patients and select surgical approaches, with significant implications for surgical planning, hospital resource allocation, and patient consent discussions.
Originaltitel: Complications of PI to PIII hemipelvic resections for intermediate and malignant tumours
**Megaproteser överträffar biologiska rekonstruktioner vid bäckenresektioner för cancertumörer** Kirurgisk behandling av mellanliggande och elakartade bäckentumörer medför höga komplikationsrisker. En systematisk litteraturöversikt av 90 studier med 2 199 patienter visar att infektioner förekommer i 15 procent av fallen, sårsäringsproblem i 13 procent och trombos i 4 procent. Implantatet behövde bytas eller avlägsnas hos 14 procent. Återanvändning av benvariga material (biologiska rekonstruktioner) gav sämre resultat än skräddarsydda metallproteser: högre frekvens av nervskador, implantatfel och behov av omoperationer. Biologiska rekonstruktioner ledde också oftare till sekundär hemipelvektomi jämfört med metallproteser eller ingen rekonstruktion. Fynden kommer från Karolinska Institutet tillsammans med europeiska och brittiska centrum. För regionvården innebär detta att protetisk rekonstruktion bör prioriteras vid urval av operationsmetod för att minska omoperationsfrekvensen och långtidsmorbiditeten.
Aims Surgical management of intermediate and malignant tumours in the pelvis is complex. Complications are frequent and either related to the surgery itself or to post-surgical failure of the reconstruction technique. This systematic review and meta-analysis aims at analyzing all reported complications following PI to PIII pelvic resections for intermediate and malignant tumours. Methods Based on a systematic literature search on PubMed adhering to the PRISMA guidelines, 1,683 study records were identified, of which we included 90 original studies published until 22 July 2025. Overall complication rates were assessed with random-effects meta-analysis. Differences in complication rates between reconstruction types (i.e. megaprosthetic, mostly biological, none) were evaluated with meta regression analysis. Results Data on 2,199 patients (1,250 males (57%)) with mainly PI to PIII pelvic resections were analyzed. The most common reconstruction types were custom-made implants (21%; n = 451) and ice-cream cone prostheses (14%; n = 312). Pooled rates of infections, wound healing problems, nerve injuries, and deep vein thrombosis (DVT) amounted to 15% (95% CI 12% to 18%), 13% (95% CI 10% to 15%), 7% (95% CI 5% to 9%), and 4% (95% CI 2% to 6%), respectively. Further, pooled implant revision/removal and secondary external hemipelvectomy rates were 14% (95% CI 11% to 17%) and 4% (95% CI 3% to 5%). Mostly biological reconstructions were associated with higher rates of nerve injuries (p < 0.001), construct failures (p = 0.010), and secondary implant revision/removal (p = 0.003) compared to megaprosthetic reconstruction. Further, biological reconstructions were associated with increased secondary external hemipelvectomy rates compared to megaprosthetic reconstructions (p = 0.005) or no reconstructions (p = 0.001). Conclusion Treatment of pelvic malignancies is challenging, with technically demanding resections and complex reconstructions. Across all reconstruction techniques following sacrum-sparing pelvic resections, infections and wound healing problems are the most common complications, yet there is also a considerable proportion of patients with neurovascular complications and DVTs. Cite this article: Bone Jt Open 2026;7(6):713–723.