Background: The development of new technologies, the interpretation of amputations as therapeutic failures by society, and the high morbidity and mortality associated with external hemipelvectomies make these mutilating surgical procedures appear obsolete. Herein, we review the scientific literature on the topic and present two cases of high-grade ulcerated soft tissue sarcomas in the gluteal region which show exceptional behavior and different outcomes. Methods: We performed a literature review of the PubMed databases from 2014 to April 2024. Additionally, we present two cases of soft tissue sarcomas in an 18-year-old female patient and in a 71-year-old female patient, which were treated with extended external hemipelvectomies with anterior flap, in combination with an abdominoperineal amputation and a colostomy in one case. Results: After 4 years of follow-up, case 1 is living a relatively normal life. She had an uncomplicated pregnancy and a cesarean section delivery. Case 2 underwent emergency surgery for intestinal perforation and sepsis. She died 2.5 months following the surgery. Conclusions: External hemipelvectomy for soft tissue sarcoma treatment is a demanding surgical procedure with purpose in selected cases after review by multidisciplinary committees and with informed patient consent. This should be similarly individualized and extended to other pathologies when possible.
背景：新技术的进步、社会将截肢视为治疗失败的观点，以及外部半骨盆切除术伴随的高发病率与死亡率，使得这类致残性外科手术显得过时。本文回顾了该主题的相关科学文献，并呈现两例臀部区域高级别溃疡性软组织肉瘤的病例，这些病例展现出特殊的行为模式和不同的临床结局。方法：我们对2014年至2024年4月期间的PubMed数据库进行了文献综述。此外，我们报告了两例软组织肉瘤病例，患者分别为18岁女性与71岁女性，均接受了带前侧皮瓣的扩大外部半骨盆切除术，其中一例联合进行了腹会阴联合切除术及结肠造口术。结果：经过4年随访，病例1目前生活相对正常，期间经历了一次无并发症的妊娠并接受了剖宫产分娩。病例2因肠穿孔和脓毒症接受了急诊手术，并于术后2.5个月死亡。结论：用于治疗软组织肉瘤的外部半骨盆切除术是一项技术要求高且具有特定适应症的手术，需经多学科委员会评估并获得患者知情同意后方可实施。该治疗策略应个体化实施，并在条件允许时推广至其他适应症。
External Hemipelvectomy in Soft Tissue Sarcomas: Are They Still Needed?
肿瘤(癌症)患者之家