External Hemipelvectomy in Soft Tissue Sarcomas: Are They Still Needed?

Background: The development of new technologies, interpretation of amputations as therapeutic failures by society, and 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 showing exceptional behavior and different outcomes. Methods: We performed a literature review of the PubMed databases from 2022 to April 2024. Additionally, we present two cases of soft tissue sarcomas in 18- and 71-years old female patients, which were treated with extended external hemipelvectomies with anterior flap and in combination with abdomino-perineal amputation and colostomy in one case. Results: At 4 years of follow-up, case one is living a relatively normal life. She had an uncomplicated pregnancy and a cesarean section delivery. Case two underwent emergency surgery for intestinal perforation and sepsis. She died 2.5 months following the surgery. Conclusion: 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